Impact of Anemia on Cardiovascular Events and All-Cause Death Among Participants Who Received Intense Blood Pressure Treatment: A Secondary Analysis of SPRINT

Xiaochuan Liu^1,†, Beiru Lin^2,†, Sichen Yao^3,4, Zhigang Pan^1,*

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¹ Department of General Practice, Zhongshan Hospital, Fudan University, 200032 Shanghai, China

² Department of General Practice, Hainan West Central Hospital, 571700 Danzhou, Hainan, China

³ Department of General Practice, Wujing Community Health Service Center, 200241 Shanghai, China

⁴ Center of Community-Based Health Research, Fudan University, 200032 Shanghai, China

^*Correspondence: zhigang_pan@163.com (Zhigang Pan)
^†These authors contributed equally.

Rev. Cardiovasc. Med. 2024, 25(1), 6; https://doi.org/10.31083/j.rcm2501006

Submitted: 14 August 2023 | Revised: 16 September 2023 | Accepted: 25 September 2023 | Published: 8 January 2024

This is an open access article under the CC BY 4.0 license.

Abstract

Background: To investigate whether anemia is associated with incident cardiovascular events and all-cause death among participants who received intensive blood pressure (BP) treatment in the Systolic Blood Pressure Intervention Trial (SPRINT). Methods: A total of 4394 participants who received intensive BP control (systolic BP $<$ 120 mmHg) in SPRINT were included. Anemia status was self-reported. Our primary outcome was a composite of cardiovascular events, and the secondary outcome was all-cause death. Cox regression was used to compare the incidence of outcomes between participants with anemia and non-anemia. In order to balance the baseline characteristics between the 2 groups, inverse probability of treatment weighting (IPTW) was applied. Hazard ratios (HRs), along with 95% confidence intervals (CIs), were then calculated. Results: There were 4394 participants who received intensive BP control (537 participants with anemia). Participants with anemia were older (mean age 68.86 versus 67.75, p = 0.01) and more likely to be female (64.8% versus 31.8%, p $<$ 0.001). The presence of anemia was strongly associated with composite cardiovascular events after adjusting for potential confounders (HR 1.66, 95% CI 1.18–2.34, p = 0.004). The association remained statistically significant even in the population after IPTW (HR 1.55, 95% CI 1.06–2.27, p = 0.024). The secondary outcome revealed that participants with anemia had a higher rate of all-cause death compared to those without anemia. The HR of all-cause death for participants with anemia was 1.61 (95% CI 1.00–2.57, p = 0.049) in the population after IPTW. Conclusions: Anemia appears to be an independent risk factor for composite cardiovascular events and all-cause death among participants who received intensive BP control in SPRINT. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062. All SPRINT anonymized data can be found at the National Heart, Lung and Blood Institute (NHLBI) Biologic Specimen and Data Repository (https://biolincc.nhlbi.nih.gov/home/).

Keywords

SPRINT

blood pressure

intensive

anemia

low hemoglobin

cardiovascular disease

Funding

H2020–027/Project of Common Chronic Disease Education and Decision Support cooperated between Ping An Healthcare and Technology Co., Ltd. and Zhongshan Hospital of Fudan University

2023ZSFZ03/Institutional research project of Zhongshan hospital

Figures

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