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.