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Conference Coverage: Highlights from the American Heart Association’s Scientific Sessions 2023

November 17, 2023

The American Heart Association’s (AHA) Scientific Sessions just wrapped up on November 13, 2023. Late breaking results from clinical trials presented during the sessions include cardiovascular outcomes associated with the use of semaglutide in nondiabetic patients who are overweight or obese, and whether more liberal transfusion strategies should be used in patients with acute MI. Other sessions covered noteworthy findings related to blood pressure management. Read on for our takeaways ...

How quickly—and significantly—does a low-sodium diet impact blood pressure?

People who followed a low-salt diet for just one week experienced a reduction in systolic blood pressure (BP) of about 6 mm Hg, according to a new multicenter cohort study. The Coronary Artery Risk Development in Young Adults – Salt Sensitivity of Blood Pressure (CARDIA-SSBP) trial included 213 participants between the ages of 50 and 75 years who had normotension (25%), controlled hypertension (20%), uncontrolled hypertension (31%), and untreated hypertension (25%). Patients attended a baseline visit while consuming their regular diet, and then completed one week each of high- and low-sodium diets.

While consuming usual, high-sodium, and low-sodium diets, participants’ median systolic BP measures were 125, 126, and 119 mm Hg, respectively. The median within-individual change in mean arterial pressure between high- and low-sodium diets was 4 mm Hg (interquartile range [IQR], 0-8 mm Hg; P < .001), which did not significantly differ by hypertension status. Compared with the high-sodium diet, the low-sodium diet induced a decline in mean arterial pressure in 73.4% of individuals. At the end of the first dietary intervention week, the mean systolic BP difference between individuals allocated to a high-sodium vs a low-sodium diet was 8 mm Hg (95% confidence interval [CI], 4-11 mm Hg; P < .001), which was mostly similar across subgroups of age, sex, race, hypertension, baseline BP, diabetes, and body mass index. Read more.

SELECT: Does semaglutide reduce the incidence of adverse CV events?

Researchers found that, among patients with preexisting cardiovascular (CV) disease and overweight or obesity but no diabetes, weekly SC semaglutide (2.4 mg) was superior to placebo in reducing the incidence of CV-related mortality, nonfatal MI, or nonfatal stroke at a mean follow-up of 39.8 months.

The multicenter, double-blind, randomized, placebo-controlled Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity (SELECT) trial enrolled 17,604 patients ≥45 years of age who had preexisting CV disease and a BMI ≥27 but no history of diabetes mellitus (DM). Patients were randomly assigned 1:1 to receive once-weekly SC semaglutide at a dose of 2.4 mg or placebo. The rate of occurrence of a primary CV end-point event was 6.5% in the semaglutide group vs. 8.0% in the placebo group (hazard ratio, 0.80; 95% confidence interval, 0.72-0.90; P<0.001). The rate of adverse events leading to treatment discontinuation was 16.6% in the semaglutide group vs. 8.2% in the placebo group (P<0.001). Read more.

MINT: In MI with anemia, is a liberal transfusion strategy better?

The Myocardial Ischemia and Transfusion (MINT) trial showed that in patients with acute MI and anemia, a liberal transfusion goal (HgB ≥10 g/dL) didn't significantly reduce the risk of recurrent MI or death at 30 days compared with a restrictive strategy (HgB 7-8 g/dL). MINT randomly assigned 3,506 patients with MI and a hemoglobin level of less than 10 g per deciliter to either a restrictive transfusion strategy (HgB cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (HgB cutoff, <10 g per deciliter).

The primary endpoint was the composite of all-cause death and recurrent MI through 30 days following trial randomization. All told, a primary-outcome event occurred in 295 of 1,749 patients (16.9%) in the restrictive-strategy group and in 255 of 1,755 patients (14.5%) in the liberal-strategy group (risk ratio [RR], 1.15; 95% confidence interval [CI], 0.99 to 1.34; P = 0.07). Death occurred in 9.9% of the patients in the restrictive strategy group compared with 8.3% of the patients in the liberal strategy group (risk ratio, 1.19; 95% CI, 0.96 to 1.47), while MI occurred in 8.5% of those in the restrictive group and 7.2% of those in the liberal strategy group (risk ratio, 1.19; 95% CI, 0.94 to 1.49). Read more.

Lowering blood pressure reduces the risk of total dementia

In this open-label, blinded-endpoint, cluster-randomized trial, China Rural Hypertension Control Project (CRHCP) researchers studied 326 villages in China and a total of 33,995 individuals aged 40 years and older who had untreated hypertension. The villages were randomly assigned to an intervention group or usual care. In the intervention group, trained village doctors initiated and titrated antihypertensive medications according to a standard protocol with supervision from primary care physicians. Village doctors also conducted health coaching on home blood pressure (BP) monitoring, lifestyle changes, and medication adherence. The primary outcome was the proportion of patients with a BP of less than 130/80 mm Hg at 18 months. At 18 months, 8,865 (57%) of 15,414 patients in the intervention group and 2,895 (19.9%) of 14,500 patients in the control group had a BP of less than 130/80 mm Hg, with a group difference of 37% (95% CI 34.9 to 39.1%; p<0·0001).

At the four-year follow-up visit, neurologists conducted cognitive function assessments and screenings. The researchers found that participants in the intervention group showed improvement in BP control (an average of 128/73 mm Hg compared to 148/81 mm Hg in the standard care group), and a 15% reduction in the risk of all-cause dementia. Read more.

Study affirms that a lower blood pressure target makes sense

In this three-year trial, intensive treatment with antihypertensive medication to reduce systolic blood pressure (BP) to less than 120 mm Hg improved outcomes and saved lives as compared with a threshold of 140 mm Hg for higher risk patients with hypertension.

The Effects of intensive Systolic blood Pressure lowering treatment in reducing RIsk of vascular evenTs (ESPRIT) trial was a multi-center, randomized controlled trial that studied the effects of intensive blood pressure-lowering treatment on the incidence of major cardiovascular (CV) events, including MI, stroke, CV death, revascularization, or hospitalization or emergency room visit for heart failure, in patients with increased CV risk. Researchers enrolled 11,255 participants aged at least 50 years old with a baseline systolic BP between 130 to 180 mm Hg at high CV risk, defined by established CV disease or two major CV risk factors. Among the participants, 28.9%, 26.9% and 38.7% had coronary heart disease, prior stroke, and diabetes mellitus, respectively.

Participants were randomized to receive either intensive blood pressure treatment or standard treatment over three years. Those in the intensive treatment group had significantly better outcomes than those receiving standard care. Compared with standard treatment, intensive treatment prevented 12% of MIs, strokes, revascularization procedures, death from CV causes, and hospitalization or emergency room visits for heart failure; 39% of deaths from CV causes; and 21% of deaths from any cause. Read more.