Table 4.
High-benefit approach vs high-risk approach
| A | ||||
|---|---|---|---|---|
| Trial sample (N = 10 672) | High-benefit approach |
High-risk approach 1 |
High-risk approach 2 |
High-risk approach 3 |
| (Based on SBP) | (Based on CVD risk score) | (Based on CVD risk score) | ||
| Treat individuals with individualized treatment effect >0 | Treat individuals with systolic blood pressure ≥130 mmHg | Treat individuals with 10-year Framingham CVD risk ≥20% | Treat individuals with 10-year ASCVD risk ≥10% | |
| No. of individuals treated | 8563 | 7943 | 6167 | 8917 |
| Sample average treatment effect (95% CI) | +9.36 pp (+8.33 to +10.44) | +1.65 pp (+0.36 to +2.84) | +2.23 pp (+0.68 to +3.70) | +1.91 pp (+0.64 to +3.06) |
| Difference (95% CI) | ref | +7.71 pp (+6.79 to +8.67) | +7.13 pp (+6.02 to +8.29) | +7.45 pp (+6.64 to +8.30) |
| Number needed to treat (95% CI) | 11 (10 to 12) | 61 (35 to 276) | 45 (27 to 147) | 52 (33 to 155) |
| B | ||||
|---|---|---|---|---|
| Target population (N = 14 575) | High-benefit approach |
High-risk approach 1 |
High-risk approach 2 |
High-risk approach 3 |
| (Based on SBP) | (Based on CVD risk score) | (Based on CVD risk score) | ||
| Treat individuals with individualized treatment effect >0 | Treat individuals with systolic blood pressure ≥130 mmHg | Treat individuals with 10-year Framingham CVD risk ≥20% | Treat individuals with 10-year ASCVD risk ≥10% | |
| No. of individuals treated | 11 320 | 8829 | 9924 | 12 690 |
| Population average treatment effect (95% CI) | +8.85 pp (+6.78 to +10.79) | +1.55 pp (−0.54 to +3.50) | +1.76 pp (−1.00 to +4.22) | +1.67 pp (−0.56 to +3.63) |
| Difference (95% CI) | ref | +7.31 pp (+5.66 to +8.95) | +7.10 pp (+5.72 to +8.67) | +7.16 pp (+6.14 to +8.28) |
| Number needed to treat (95% CI) | 11 (9 to 15) | 64 (29 to ∞) | 57 (24 to ∞) | 60 (28 to ∞) |
Outcome was the reduction in % of primary composite CVD outcomes during a 3-year follow-up. The 95% confidence intervals (CIs) were calculated using 1000 bootstrapped samples. The average treatment effect and number needed to treat of each approach were obtained using the sample from the combined database of SPRINT and ACCORD-BP (trial sample), along with inverse-odds weights to emulate the trial sample to the NHANES participants. Number needed to treat was calculated by 1/average treatment effect. The 10-year ASCVD risk for high-risk approach 3 was calculated by ACC/AHA pooled cohort equation.
SPRINT, Systolic Blood Pressure Intervention Trial; ACCORD-BP, Action to Control Cardiovascular Risk in Diabetes Blood Pressure; NHANES, National Health And Nutrition Examination Survey; SBP, systolic blood pressure; CVD, cardiovascular disease; ASCVD, atherosclerotic cardiovascular disease; pp, percentage points.