From the Guidelines
The SPRINT trial demonstrated that targeting a systolic blood pressure of less than 120 mmHg is beneficial for adults with hypertension and a high risk of cardiovascular disease (CVD), particularly those with clinical or subclinical CVD, chronic kidney disease, or a 10-year Framingham risk score ≥15%. The trial showed that a more intensive intervention significantly reduced the primary outcome (CVD composite) by about 25% and the incidence of heart failure (HF) by 38% (hazard ratio: 0.62; 95% confidence interval: 0.45–0.84) 1. The patients who would benefit from this intensive approach include those with high cardiovascular risk, such as non-diabetic adults aged 50 and older.
Key Patient Groups to Target
- Adults with hypertension (SBP ≥130 mm Hg or DBP ≥80 mm Hg) and a high risk of CVD
- Patients with clinical or subclinical cardiovascular disease
- Patients with chronic kidney disease (with eGFR 20-60 ml/min/1.73m²)
- Patients with a 10-year Framingham risk score ≥15%
- Patients aged ≥75 years
Implementation of Intensive Blood Pressure Management
The approach involves using a combination of antihypertensive medications, including thiazide diuretics, ACE inhibitors or ARBs, and calcium channel blockers, titrating doses and adding medications as needed to reach the target 1. Blood pressure should be measured using standardized office readings after 5 minutes of quiet rest with the patient alone. Regular monitoring of kidney function, electrolytes, and symptoms of hypotension is essential when implementing this strategy.
From the Research
SPRINT Trial Overview
- The SPRINT trial showed a beneficial effect of systolic blood pressure treatment targets of 120 mmHg on cardiovascular risk compared to targets of 140 mmHg 2.
- The trial found that lowering blood pressure prevents cardiovascular disease, but not all the positive effects could be explained by the change in systolic blood pressure 2.
Patient Characteristics
- The SPRINT trial included patients with hypertension and an elevated cardiovascular risk, but without diabetes 3.
- The patient population with characteristics like those in SPRINT makes up only 20-30% of the total hypertensive population 4.
- The trial suggests that treatment should be continued and not reduced when treated systolic blood pressure is <130, especially for patients with characteristics similar to those in the SPRINT trial 5.
Target Blood Pressure
- The SPRINT trial found that targeting a systolic blood pressure of less than 120 mmHg resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, compared to targeting less than 140 mmHg 3.
- The trial suggests that intensive blood pressure control, with a target systolic blood pressure of <120 mmHg, may be beneficial for patients at high risk for cardiovascular events, but without diabetes 6.
- Increasing the percentage of treated adults with systolic blood pressure <140 could approximate SPRINT intensive treatment systolic blood pressure without lowering treatment goals 5.
Implications for Hypertension Management
- The SPRINT trial highlights the need to consider lower blood pressure goals in the treatment of hypertension, especially for patients at high risk for cardiovascular events 4.
- The trial's findings have implications for future management guidelines and may lead to changes in the way hypertension is treated, especially for patients with characteristics similar to those in the SPRINT trial 6, 5.