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

• Published in: Hypertension (Dallas, Tex. 1979) Tex. 1979), 2021-10, Vol.78 (4), p.983-995
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Aged; Blood Pressure; Cardiovascular Diseases - prevention & control; Female; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertension - physiopathology; Life Sciences; Male; Middle Aged; Original; Prospective Studies; Pulse Wave Analysis; Vascular Stiffness - drug effects; Vascular Stiffness - physiology
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/HYPERTENSIONAHA.121.17579

The SPARTE study (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness; URLhttps://www.clinicaltrials.gov; Unique identifierNCT02617238) 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], P=0.35). In the PWV group, combinations of renin-angiotensin-system blockers and calcium channel blockers were prescribed at higher dosage (P=0.028), office and ambulatory systolic blood pressure and diastolic blood pressure decreased more (P