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

From the Guidelines

The SPRINT trial provides strong evidence to support lower blood pressure goals in individuals at increased cardiovascular risk, with a recommended systolic blood pressure target of <120 mmHg, despite the potential for increased adverse outcomes such as hypotension, syncope, electrolyte abnormality, and acute kidney injury. 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, with achieved systolic blood pressures of 121 mmHg and 136 mmHg in the intensive versus standard treatment group, respectively 1. Key findings from the trial include:

• The primary composite outcome was reduced by 25% in the intensive treatment group
• Achieved systolic blood pressures were 121 mmHg and 136 mmHg in the intensive versus standard treatment group, respectively
• Adverse outcomes, including hypotension, syncope, electrolyte abnormality, and acute kidney injury, were more common in the intensive treatment arm The results of the SPRINT trial are consistent with other studies, such as the ACCORD trial, which did not document a statistically significant reduction in the primary outcome with intensive versus standard BP lowering, but was underpowered to detect a difference between treatment groups 1. Overall, the SPRINT trial provides strong evidence to support the use of intensive blood pressure lowering to reduce cardiovascular risk, and the benefits of this approach should be weighed against the potential risks and individualized to each patient's specific needs and circumstances.

From the Research

Overview of the SPRINT Trial

• The SPRINT trial was a randomized controlled trial that compared the effects of intensive blood pressure control (target systolic blood pressure <120 mmHg) with standard blood pressure control (target systolic blood pressure <140 mmHg) on cardiovascular outcomes in patients with high cardiovascular risk but without diabetes 2.
• The trial found that intensive blood pressure control reduced the risk of major cardiovascular events, such as myocardial infarction, stroke, and heart failure, by 25% compared to standard blood pressure control 2, 3.

Key Findings of the SPRINT Trial

• The trial demonstrated that intensive blood pressure control resulted in lower rates of fatal and nonfatal major cardiovascular events, as well as lower all-cause mortality, compared to standard blood pressure control 2, 4.
• The trial also found that intensive blood pressure control was associated with higher rates of certain adverse events, such as hypotension, syncope, and electrolyte abnormalities, but not injurious falls 2.
• The estimated residual life span was longer with intensive blood pressure control compared to standard blood pressure control, with a difference of 2.9 years at age 50 and 1.1 years at age 65 4.

Comparison with Other Studies

• A study comparing angiotensin-converting enzyme inhibitors (ACE inhibitors) with angiotensin receptor blockers (ARBs) found no difference in total mortality or cardiovascular outcomes, but ARBs caused slightly fewer withdrawals due to adverse effects 5.
• Another study found that combination therapy with a calcium channel blocker and an ACE inhibitor was more effective in preventing composite cardiovascular events than combination therapy with hydrochlorothiazide and an ACE inhibitor, even in patients achieving aggressive systolic blood pressure targets or with apparent resistant hypertension 6.