Intensive blood pressure lowering might enhance patient wellbeing, after the deeper analysis of the ESPRIT trial demonstrated that lowering systolic BP to <120 mmHg leads to modest but significant improvements in health-related quality of life.
- Intensive BP-lowering treatment targeting has proven CV benefits, but many worry that aggressive targets might lead to excessive medical burden and adverse events.
- Previous trials (ACCORD, SPRINT) found no significant QoL differences between intensive and standard treatment, but lacked follow-up duration alongside high missing data rates.
- BP related quality of life is often measured using the EQ-5D-5L questionnaire which evaluates mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.
To fill in these gaps, the ESPRIT QoL analysis examined 5.4k intensive treatment and 5.4k standard treatment participants over a 3.4-year follow-up, using the EQ-5D-5L questionnaire to evaluate the differences between patient QoL and found that…
- EQ-5D scores increased by 0.56 points with intensive treatment versus decreased by 0.50 points with standard treatment, suggesting better QoL for the intensive group.
- Intensive treatment led to a 16% higher likelihood of meaningful improvement, while standard treatment led to worsening quality of life.
- No significant differences were found across the five EQ-5D domains between treatment groups.
Considering the widespread clinical hesitation about intensive BP targets due to quality-of-life concerns, these findings provide real world patient-centered evidence supporting more aggressive treatment in high-risk hypertensive populations.
- For example, the study’s robust sample size (>10,000 participants) provides the evidence previously lacking from earlier trials that faced limited follow-up and completeness.
- Moreover, patient-reported outcomes increasingly drive treatment decisions, making this QoL data essential for decision-making about BP targets.
The Takeaway
The results of ESPRIT’s quality-of-life analysis could help dispel concerns that intensive blood pressure control impairs patient wellbeing through excessive treatment burden. On the contrary, it appears that intensive treatment actually improves health-related quality of life while reducing cardiovascular events.
