What is a summary of the SPRINT (Systolic Blood Pressure Intervention Trial) trial?

From the Guidelines

Intensive blood pressure control targeting systolic BP below 120 mmHg is recommended for individuals with increased cardiovascular risk, as it significantly reduces cardiovascular events and mortality compared to standard treatment targeting below 140 mmHg, as evidenced by the SPRINT trial 1. The SPRINT trial, which enrolled 9,361 individuals with a systolic blood pressure of 130 mmHg and increased cardiovascular risk, demonstrated a 25% reduction in the primary composite outcome of MI, coronary syndromes, stroke, heart failure, or death from cardiovascular causes in the intensive treatment group 1. Key aspects of the trial include:

• The achieved systolic blood pressures in the trial were 121 mmHg and 136 mmHg in the intensive versus standard treatment group, respectively 1
• Adverse outcomes, including hypotension, syncope, electrolyte abnormality, and acute kidney injury (AKI), were more common in the intensive treatment arm 1
• The benefits of intensive blood pressure control must be weighed against the potential risks of adverse outcomes, and treatment should be individualized based on patient characteristics, comorbidities, and tolerance of medications. Implementation of intensive blood pressure control requires:
• Close monitoring with BP checks every 1-3 months initially
• Laboratory monitoring for electrolyte abnormalities or kidney function changes
• Attention to potential side effects like hypotension, syncope, electrolyte disturbances, and acute kidney injury. The SPRINT trial provides the strongest evidence to support lower blood pressure goals in individuals at increased cardiovascular risk, although it excluded people with diabetes 1.

From the Research

Sprint Trial Summary

• The SPRINT trial was a randomized trial that compared intensive versus standard blood-pressure control in patients with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes 2, 3.
• The trial found that targeting a systolic blood pressure of less than 120 mm Hg resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group 2, 3.
• The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes, and the intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group 2, 3.

Key Findings

• The mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the standard-treatment group at 1 year 2, 3.
• All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003) 2, 3.
• Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensive-treatment group than in the standard-treatment group 2, 3.

Implications

• The SPRINT trial results suggest that treatment should be continued and not reduced when treated systolic blood pressure is <130, especially for patients at high risk for cardiovascular events but without diabetes 4.
• Increasing the percentage of treated adults with systolic blood pressure <140 could approximate SPRINT intensive treatment systolic blood pressure without lowering treatment goals 4.
• The benefit of intensive blood-pressure management on mortality appeared greatest in patients with a pulse pressure ∼60 mm Hg 5.
• Intensive blood pressure control improves projected survival by 6 months to 3 years among middle-aged and older adults at high cardiovascular risk but without diabetes mellitus 6.