SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk

Medientyp: E-Artikel
Titel: SPARTE Study: Normalization of Arterial Stiffness and Cardiovascular Events in Patients With Hypertension at Medium to Very High Risk
Beteiligte: Laurent, Stephane; Chatellier, Gilles; Azizi, Michel; Calvet, David; Choukroun, Gabriel; Danchin, Nicolas; Delsart, Pascal; Girerd, Xavier; Gosse, Philippe; Khettab, Hakim; London, Gerard; Mourad, Jean-Jacques; Pannier, Bruno; Pereira, Helena; Stephan, Dominique; Valensi, Paul; Cunha, Pedro; Narkiewicz, Krzysztof; Bruno, Rosa-Maria; Boutouyrie, Pierre
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2021
Erschienen in: Hypertension
Sprache: Englisch
DOI: 10.1161/hypertensionaha.121.17579
ISSN: 1524-4563; 0194-911X
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Beschreibung: <jats:p> The SPARTE study (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness; URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> ; Unique identifier: NCT02617238) is a multicenter open-label randomized controlled trial with blinded end point evaluation, undertaken at 25 French research centers in university hospitals. Patients with primary hypertension were randomly assigned (1:1) to a therapeutic strategy targeting the normalization of carotid-femoral pulse wave velocity (PWV) measured every 6 months (PWV group, n=264) versus a classical therapeutic strategy only implementing the European Guidelines for Hypertension Treatment (conventional group, n=272). In the PWV group, the therapeutic strategy used preferably a combination of ACE (angiotensin-converting enzyme) inhibitor or angiotensin receptor blocker and calcium channel blockers, as well as maximal recommended doses of ACE inhibitors and angiotensin receptor blockers. The primary outcome was a combined end point including particularly stroke and coronary events. Secondary outcomes included the time-course changes in brachial office blood pressure (BP), ambulatory BP, PWV, and treatments. After a median follow-up of 48.3 months, there was no significant between-group difference in primary outcome (hazard ratio, 0.74 [95% CI, 0.40–1.38], <jats:italic>P</jats:italic> =0.35). In the PWV group, combinations of renin-angiotensin-system blockers and calcium channel blockers were prescribed at higher dosage ( <jats:italic>P</jats:italic> =0.028), office and ambulatory systolic blood pressure and diastolic blood pressure decreased more ( <jats:italic>P</jats:italic> <0.001 and <jats:italic>P</jats:italic> <0.01, respectively), and PWV increased less ( <jats:italic>P</jats:italic> =0.0003) than in the conventional group. The SPARTE study lacked sufficient statistical power to demonstrate its primary outcome. However, it demonstrated that a PWV-driven treatment for hypertension enables to further reduce office and ambulatory systolic blood pressure and diastolic blood pressure and prevent vascular aging in patients with hypertension at medium-to-very-high risk, compared with strict application of guidelines. </jats:p>
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