International Society of Hypertension

Can we translate the results of SPRINT into clinical practice?

The much awaited results of the Systolic Blood Pressure Intervention Trial (SPRINT) have recently been published.

Observational studies have shown a linear relationship between systolic blood pressure (SBP) and cardiovascular disease (CVD) risk rising from 115 mm Hg. Randomised controlled trials have shown that lowering the SBP by approximately 10 mm Hg reduces the risk of stroke by 35-40%, myocardial infarction by 15-25% and heart failure by up to 65%. The target for blood pressure lowering has, however, been uncertain. Previously available data have clearly shown the benefits of lowering SBP to below 150 mm Hg, whilst most hypertension guidelines have recommended lowering SBP to below 140 mm Hg (below 150 mm Hg in patients aged 80 years or above).

The much awaited results of the Systolic Blood Pressure Intervention Trial (SPRINT) have recently been published [1]. In this landmark study, 9 361 high risk patients without diabetes mellitus or a previous stroke (mean age 68, 65% men), with a SBP of 130 mm Hg or higher, were randomised to intensive (SBP <120 mm Hg) or standard (SBP <140 mm Hg) blood pressure control.

More than 90% in both randomised groups were receiving blood pressure lowering drug treatment at baseline. The mean number of drugs was 1.8 at baseline, increasing to 2.8 in the intensive-treatment group during the study period. Medications for patients in the intensive-treatment group were adjusted on a monthly basis to a SBP target of less than 120 mm Hg. For those in the standard-treatment group, medications were adjusted to a SBP target of 135-139 mm Hg; the dose was reduced if SBP was less than 130 mm Hg at a single visit. Mean SBP at baseline was 140 (SD 16) mm Hg in both groups. Throughout the follow-up this dropped to 121 mm Hg in the intensive-treatment group compared with 135 mm Hg in the standard-treatment group - a 14 mm Hg difference. Importantly, blood pressure was recorded with an automated device, (Model 907, Omron Healthcare) after five minutes rest in an office free from staff. The mean of three recordings was calculated and used in the analyses.

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