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Grand Rounds

Final Report from the SPRINT Trial: Does Intensive BP Treatment Lead to Fewer Cardiovascular Events?

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BACKGROUND AND PURPOSE:

  • Previous data from the SPRINT trial showed that intensive blood pressure therapy (systolic blood-pressure [SBP] target <120 mm Hg) was associated with fewer clinical events than standard treatment (target <140 mm Hg)
  • The SPRINT research group (NEJM, 2021) updated the analysis of all events through 2016 and included data from post-trial close out visits

METHODS:

  • 2-arm, multicenter, randomized clinical trial
    • The Systolic Blood Pressure Intervention Trial (SPRINT)
  • Participants
    • SBP: 130 to 180 mm Hg
    • With or without antihypertensive medications   
    • ≥1 additional CVD risk factor
    • No diabetes, dementia, or previous stroke
  • Interventions
    • Intensive treatment target: SBP <120 mm Hg
    • Standard treatment target: SBP <140 mm Hg
  • Study design
    • Additional primary outcome events occurring through the end of the intervention period (August 20, 2015) were adjudicated after data lock for the primary analysis
  • Primary outcome
    • Composite of: MI | Other acute coronary syndromes | Stroke | Acute decompensated heart failure | Death from cardiovascular causes

RESULTS:

  • 9361 participants | Median 3.3 years follow-up
  • Rate of the primary outcome and all-cause mortality were significantly lower in the intensive-treatment group
    • Rate of primary composite outcome
      • Intensive: 1.77% per year
      • Standard: 2.40% per year
      • Hazard ratio (HR) 0.73 (95% CI, 0.63 to 0.86)
    • All-cause mortality
      • Intensive: 1.06% per year
      • Standard: 1.41% per year
      • HR 0.75 (95% CI, 0.61 to 0.92)
  • Serious adverse events
    • Significantly more frequent in the intensive-treatment group
    • Hypotension | Electrolyte abnormalities | Acute kidney injury or failure | Syncope
    • Majority of kidney events were solitary and generally mild
    • Hypotension and syncope more likely among those with chronic kidney disease, frailty, or older age
  • Combined trial and post-trial follow-up data (3.88 years total)
    • Similar patterns found for treatment benefit and adverse events
    • Rates of heart failure no longer differed between the groups

CONCLUSION:

  • For people at an increased risk of cardiovascular events, an intensive treatment target (systolic BP <120 mm Hg) led to fewer cardiovascular events and lower all-cause mortality
  • Rates of adverse events were higher in the intensive treatment group
  • The authors conclude

When data from the intervention and postintervention periods were combined, the benefits of intensive treatment with respect to the primary outcome and all-cause mortality remained highly significant and similar in magnitude to effects seen during the trial

Learn More – Primary Sources:

Final Report of a Trial of Intensive versus Standard Blood-Pressure Control

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What is the Optimal Blood Pressure Target When Treating Hypertension?
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