From the Guidelines
The SPRINT trial demonstrated that intensive blood pressure management, targeting a systolic blood pressure of less than 120 mmHg, significantly reduced the risk of cardiovascular disease and all-cause mortality compared to a standard target of less than 140 mmHg. This finding is based on the results of the Systolic BP Intervention Trial (SPRINT), which showed that intensive lowering of systolic BP to a target < 120 mm Hg reduced risk for cardiovascular disease (CVD) and all-cause mortality compared with a standard BP target of < 140 mm Hg, as reported in the Journal of the American Society of Nephrology 1. The trial's results were similar in patients with and without chronic kidney disease (CKD).
Key Findings
- The intensive blood pressure management approach reduced the risk of cardiovascular events and death in non-diabetic adults with hypertension who were at high cardiovascular risk.
- The trial used a combination of antihypertensive medications, typically requiring an average of three medications to achieve the lower target, including thiazide diuretics, calcium channel blockers, ACE inhibitors, and ARBs.
- However, the intensive treatment group did experience more adverse events such as hypotension, syncope, electrolyte abnormalities, and acute kidney injury.
Implementation
- To implement this approach, patients would need more frequent monitoring, especially in the early phase of treatment, with blood pressure measurements taken after 5 minutes of quiet rest using automated devices, as recommended by the American Heart Association (AHA) 1.
- The findings suggest that for high-risk hypertensive patients without diabetes, more aggressive blood pressure control may provide substantial cardiovascular benefits, though the potential risks must be considered on an individual basis.
From the Research
SPRINT Trial Overview
- The SPRINT trial was a randomized clinical trial that aimed to determine the effects of intensive blood pressure lowering on cardiovascular outcomes in patients with hypertension 2, 3, 4.
- The trial included patients with systolic blood pressure between 130-180 mmHg and randomly assigned them to either intensive or standard antihypertensive treatment 2.
Key Findings
- The SPRINT trial showed that intensive blood pressure lowering (target systolic blood pressure <120 mmHg) compared to standard blood pressure lowering (target systolic blood pressure <140 mmHg) resulted in lower rates of developing new left ventricular hypertrophy (LVH) in patients without LVH and higher rates of regression of LVH in patients with existing LVH 3.
- The trial also found that intensive blood pressure lowering reduced the risk of cardiovascular events, including myocardial infarction, stroke, heart failure, and death from cardiovascular causes, particularly in patients with high or intermediate cardiovascular risk 4.
- The benefit of intensive blood pressure lowering on mortality was greatest in patients with a pulse pressure of approximately 60 mmHg 2.
Implications for Hypertension Management
- The SPRINT trial suggests that intensive blood pressure lowering may be beneficial for patients with hypertension, particularly those with high or intermediate cardiovascular risk 4.
- The trial's findings support the use of a systolic blood pressure target of <120 mmHg in patients with hypertension, particularly those with high cardiovascular risk 3, 4.
- However, the trial also highlights the importance of individualizing treatment and considering factors such as pulse pressure and cardiovascular risk when determining the optimal blood pressure target for each patient 2.