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The Systolic Blood Pressure Intervention Trial (SPRINT) showed that among older adults with hypertension and a high risk of cardiovascular disease, but without prevalent diabetes or a history of stroke, blood-pressure treatment that targeted a systolic blood pressure of less than 120 mm Hg (intensive treatment) led to lower rates of cardiovascular events and death than treatment that targeted a systolic blood pressure of less than 140 mm Hg (standard treatment).1 The adoption of the lower blood-pressure target into clinical practice may be limited by concerns regarding its effect on patient-reported outcomes, such as health status, quality of life, and satisfaction with care.2–4 Although lower rates of cardiovascular events associated with intensive treatment could result in improved health status, serious adverse events associated with low end-organ perfusion, including symptomatic hypotension, syncope, and acute kidney injury, were more common among trial participants who were randomly assigned to intensive treatment.1 Reductions in cerebral blood flow, especially among older patients who have hypertension as well as physical and cognitive impairment, may lead to light-headedness, confusion, and depression.3,5,6 Participants with a target systolic blood pressure of less than 120 mm Hg received an average of one additional antihypertensive medication.1 Antihypertensive medications may have negative effects on health-related quality of life.7 Therefore, it is important to evaluate the effect of intensive treatment for hypertension, not only on the rates of cardiovascular events and death, but also on outcomes that are important to a patient’s perception of well-being and satisfaction.
Using patient-reported outcomes from the trial,1 we sought to address three questions. First, did patients randomly assigned to intensive blood-pressure control perceive their health status, as measured by patient-reported outcomes of physical and mental health, differently from patients randomly assigned to standard treatment? Second, did older patients who had hypertension as well as lower physical and cognitive function have different patient-reported outcomes depending on whether they were receiving intensive or standard antihypertensive treatment? Third, because adverse effects from medications may lead to poor adherence to treatment, did intensive treatment affect patient-reported adherence to treatment?
Methods
Trial Design and Oversight
The trial design and primary results have been published previously.1,8 In brief, we conducted a...