OBJECTIVES: Despite reducing cardiovascular disease (CVD) events and mortality in the Systolic Blood Pressure Intervention Trial (SPRINT), intensive systolic blood pressure (SBP) goals are not readily used in the US. This analysis projected long-term SBP and CVD outcomes of hypertensive treatment strategies in SPRINT-eligible US adults.

METHODS: The validated BP Control Model-CVD Policy Model, a discrete event simulation of hypertension care processes and CVD outcomes, was populated with 25,000 SPRINT-eligible US adults weighted to match SPRINT participant characteristics. The model was calibrated to replicate achieved SBP and CVD event rate from SPRINT at 3.26 years (median trial follow up). In the SPRINT standard (<140 mmHg) and intensive (<120 mmHg) SBP arms, hypertension care was per the SPRINT protocol. In the usual care and team-based care (TBC; pharmacists titrating antihypertensives) arms, BP goal was per current guidelines (<130/80 mmHg), physician visit frequency based on national sources, and TBC visit frequency from a meta-analysis. Outcomes were projected SBP and CVD event cumulative incidence at 10 years.

RESULTS: Mean baseline age was 69.6 years; 37.3% were female and 27.1% were Black. Mean (95% uncertainty interval) SBP was projected to decrease from 138.6 mmHg at baseline, to 135.2 (132.6-134.5) mmHg, 123.0 (120.1-122.3) mmHg, 131.2 (130.9-133.2) mmHg, and 123.2 (122.4-123.8) mmHg at 10 years with SPRINT standard, SPRINT intensive, usual care, and TBC, respectively. Projected CVD event cumulative incidence was 18.8% (16.3%-24.8%), 15.5% (12.9%-21.2%), 17.6% (15.7%-23.8%), and 15.6% (13.1%-21.5%) with SPRINT standard, SPRINT intensive, usual care, and TBC, respectively. Average physician visits required were 27.8 (26.8-28.8), 32.8 (30.7-34.7), 19.6 (17.7-21.4), and 17.1 (15.9-18.3) for SPRINT standard, SPRINT intensive, usual care, and TBC, respectively. Outcomes were sensitive to frequency of TBC visits.

CONCLUSIONS: TBC with pharmacists titrating antihypertensives may be a viable alternative to intensive trial-protocolized hypertension care in SPRINT, achieving similar SBP and CVD outcomes.