Among high-risk older individuals from the Systolic Blood Pressure Intervention Trial (SPRINT), the overall efficacy and safety of intensive blood pressure (BP) lowering did not appear to be modified by baseline body mass index (BMI). The SPRINT trial included 9,361 individuals aged ≥50 years at high cardiovascular (CV) risk, without diabetes mellitus, and a systolic BP 130-180 mmHg. Participants were randomized to intensive vs standard antihypertensive treatment and evaluated for the primary composite efficacy endpoint of acute coronary syndromes, stroke, heart failure, or CV death. Researchers sought to determine the relationship between BMI, response to intensive BP lowering, and clinical outcomes. They found:

• BMI measurements could be calculated for 9,284 (99.2%) individuals; mean BMI was similar between 2 treatment groups.
• Median follow-up was 3.3 years.
• BMI had a significant, J-shaped association with risk of all-cause mortality, stroke, and serious adverse events, but these were no longer significant after accounting for key clinical factors.
• Intensive BP lowering reduced the primary efficacy endpoint consistently across the BMI spectrum.