The effects of intensive blood pressure management on rates of cardiovascular events and death vary substantially across individuals' levels of educational attainment, according to a new study from researchers at the University of Pittsburgh Schools of the Health Sciences and University of Texas at Tyler. The study was published today in the Journal of the American Heart Association .
The researchers analyzed data from the Systolic Blood Pressure Intervention Trial (SPRINT) , a multicenter, randomized controlled trial that began in 2010 and compared the effects of more aggressive blood-pressure management to what was then standard care. SPRINT showed that bringing systolic blood pressure down to 120, rather than 140 as recommended at the time, reduced rates of cardiovascular events by 25% and death by 27% — landmark results that informed new clinical guidelines in 2017.
In the current study, the researchers examined the SPRINT cohort of more than 9,000 hypertensive adults age 50 and older, categorizing trial participants by their educational attainment, and compared subgroup members' outcomes. The team found that during follow-up, blood pressure control was identical across the three levels of educational attainment: no college study, some college study through college degree, and beyond a college degree. During follow-up, SPRINT participants with the highest category of educational attainment had two-fold decreased cardiovascular risk with intensive systolic blood pressure control. In contrast, those with the lower two categories of education did not have a significant benefit.
"We determined that intensive systolic blood pressure reduction resulted in similar control of hypertension in SPRINT, regardless of educational attainment. However, only those with the highest education had the benefit of reduced cardiovascular events," said Dr. Jared W. Magnani, UPMC cardiologist and associate professor of medicine at Pitt. "The results suggest that unmeasured social and structural factors beyond pharmacologic management may inform cardiovascular risk. Further studies of social factors may elucidate how and we can improve heart health, regardless of educational attainment."
