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Intensive BP Control in Adults with Hypertension Who Smoke

JAMA Netw Open; ePub 2019 Mar 8; Scarpa, et al

Adults with hypertension who smoke may have a higher rate of cardiovascular (CV) events associated with intensive blood pressure (BP) control, a new study found. The secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) included 9,361 participants who were assigned a systolic BP target of <120 mm Hg (intervention treatment) or of <140 mm Hg (standard treatment). The primary composite CV outcome was myocardial infarction (MI), other acute coronary syndromes, stroke, heart failure, or death from CV causes. Researchers found:

  • Of the 9,361 participants, 466 (5.0%) were current smokers with systolic BP >144 mm Hg at baseline, with 230 (49.4%) randomized to the training data set and 236 (50.6%) randomized to the testing data set.
  • Smokers with systolic BP >144 mm Hg were associated with a significant increase in CV events from lower BP targets.
  • Combinations of 2 covariates (ie, baseline smoking status and systolic blood pressure) distinguished participants who were differentially affected by the intervention.


Scarpa J, Bruzelius E, Doupe P, Le M, Faghmous J, Baum A. Assessment of risk of harm associated with intensive blood pressure management among patients with hypertension who smoke: A secondary analysis of the systolic blood pressure intervention trial. JAMA Netw Open. 2019;2(3):e190005. doi:10.1001/jamanetworkopen.2019.0005.