Using SPRINT, the authors compared participants whose antihypertensive medication count fell between screening and randomisation with those whose did not, under the standard (below 140 mm Hg) and intensive (below 120 mm Hg) systolic targets. Under the standard target only 52.9% regained their screening count, after a mean of 358 days, and de-escalation carried a hazard ratio of 1.34 (1.04-1.74) for major adverse cardiovascular events. Under the intensive target, where 76.6% were re-intensified within a mean of 198 days, no excess risk was seen.
Why it is interesting: It puts a figure on the cardiovascular cost of the gap between stopping and restarting blood pressure treatment, where the stop was set by protocol rather than chosen by a clinician.