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Hypertension Global Newsletter #2
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The SPARTE Study: Normalization of arterial stiffness and cardiovascular events
in patients with hypertension at medium to very high risk.

Laurent S, et al. Hypertension 2021;78(4):983-995.
The Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness (SPARTE) study is a multicentre open-
label RCT with blinded end point evaluation that evaluated two treatment strategies in patients with primary hypertension. The
arterial stiffness normalization strategy targeted the normalization of carotid-femoral pulse wave velocity (PWV) measured every six
months (n=264). The BP-driven therapeutic strategy followed the classical approach of implementing the European Guidelines for
Hypertension Treatment (n=272).
Stiff large arteries insufficiently dampen the pulsatility of ventricular ejection; thus high pulsatile pressure and flow are transmitted
downstream to the kidney and brain, damaging these organs. Therefore, arterial stiffness integrates all damages done to the arterial
wall by hypertension and other cardiovascular risk factors and may serve as a surrogate endpoint for CVD.

After a median follow up of 48.3 months, the primary outcome, which was a combined endpoint including stroke and coronary events,
was found to be no different between the two groups (HR 0.74, 95% CI 0.40–1.38, P=0.35).
While office systolic BP was similar between the two groups at inclusion, their trajectories over time were significantly different
(P=0.001), with a greater reduction in the PWV group compared to the conventional group (-1.08 mm Hg/y vs. -0.10 mm Hg/y,
respectively). Similarly, the trajectories of PWV differed over time between the two groups. In the conventional arm, the PWV
increased with a rate of 0.20 m/s/y, while in the PWV arm, there was a nonsignificant increase of 0.06 m/s/y. In the PWV group,
maximizing doses of de-stiffening drugs such as RAS-blockers and CCBs was used.

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