Summary of “A randomized trial of standard versus intensive blood-pressure control” The SPRINT Research Group, NEJM, DOI: /NEJMoa Downloaded Nov 9, 2015 from nejm.org. Summary by W. Rose

Background “The hypothesis that a lower systolic blood- pressure goal (e.g., <120 mm Hg) would reduce clinical events more than a standard goal was designated by a National Heart, Lung, and Blood Institute (NHLBI) expert panel in 2007 as the most important hypothesis to test regarding the prevention of hypertension-related complications among patients without diabetes.”

Goal This article “describes the primary results of the Systolic Blood Pressure Intervention Trial (SPRINT), which compared the benefit of treatment of systolic blood pressure to a target of less than 120 mm Hg with treatment to a target of less than 140 mm Hg.”

Results The next two slides illustrate the key results: Patients in the intensive BP lowering group had significantly lower risk of a “primary outcome” (RR=0.75) and lower risk of death from any cause (RR=0.73) than patients in the standard therapy group. These differences were so statistically significant that the study was stopped early. All patients and their doctors were told of the results and given the option to convert to the intensive control group.

Fig. 3A. Risk of a “primary outcome” “Primary Outcome” = myocardial infarction, acute coronary syndrome, stroke, heart failure, or death from cardiovascular causes Standard versus intensive blood-pressure control, NEJM 2015.

Fig. 3B. Risk of death from any cause Standard versus intensive blood-pressure control, NEJM 2015.

Additional Results Analysis of pre-specified subgroups did not show significant differences for any subgroup, such as baseline BP; male vs, female; age =75; black race vs. non; previous CKD vs. non.

Discussion “ACCORD” trial (NEJM 2010) also tested effect of intensive BP control. Unlike SPRINT, ACCORD did not find a significant benefit of intensive BP control. Why the difference? SPRINT authors point out that 1. SPRINT had ~twice as many subjects; 2. ACCORD found a 12% reduction in RR with lowering (not signif) with a 95% CI that included a possible 27% reduction in RR, consistent with SPRINT; 3. ACCORD was diabetics only; SPRINT was non-diabetics.

Conclusions This randomized controlled trial with over 4600 subjects found that “Targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, in patients at high risk for cardiovascular events but without diabetes resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause. However, some adverse events occurred significantly more frequently with the lower target.”