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Systolic Blood Pressure Intervention Trial - SPRINT

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Systolic Blood Pressure Intervention Trial - SPRINT

  • goal of the trial was to compare the safety and efficacy of intensive lowering of systolic blood pressure (SBP) to <120 mm Hg versus routine management to <140 mm Hg

Study Design

Patients were randomized to intensive SBP lowering (target <120 mm Hg) or routine SBP management (target <140 mm Hg)

  • total number of enrollees: 9,361
  • duration of follow-up: 5 years (median 3.26 years)

Inclusion criteria:

  • age >=50 years
  • hypertension with SBP >=130 mm Hg

At least one risk factor for heart disease:

  • presence of clinical or subclinical cardiovascular disease other than stroke
  • chronic kidney disease, defined as estimated glomerular filtration rate (eGFR) 20-59 ml/min/1.73 m2
  • a Framingham Risk Score for 10-year cardiovascular disease risk> =15%
  • age >75 years

Exclusion criteria:

  • indication for a specific BP-lowering medication that the person is not taking and the person has not been documented to be intolerant of the medication class
  • known secondary cause of hypertension
  • one-minute standing SBP <110 mm Hg
  • proteinuria
  • arm circumference too large or small to allow accurate BP measurement with available devices
  • diabetes mellitus
  • history of stroke
  • polycystic kidney disease
  • glomerulonephritis treated with or likely to be treated with immunosuppressive therapy
  • eGFR <20 ml/min/1.73 m2 or end-stage renal disease
  • cardiovascular event or procedure or hospitalization for unstable angina within last 3 months
  • symptomatic heart failure within the past 6 months or left ventricular ejection fraction <35%
  • medical condition likely to limit survival to <3 years or a malignancy other than nonmelanoma skin cancer within the last 2 years
  • organ transplant

Principal Findings:

  • trial was terminated early due to overwhelming evidence of benefit. The primary outcome, myocardial infarction (MI), acute coronary syndrome (ACS), stroke, congestive heart failure (CHF), or cardiovascular (CV) death, was significantly lowered in the intensive BP management arm compared with the routine management arm (5.2% vs. 6.8%, hazard ratio 0.75, 95% confidence interval 0.64–0.89; p < 0.0001).

Individual components (event rates for intensive vs. routine management, absolute event rates):

  • MI: 2.1% vs. 2.5%, p = 0.19
  • ACS: 0.9% vs. 0.9%, p = 0.99
  • Stroke: 1.3% vs. 1.5%, p = 0.5
  • CHF: 1.3% vs. 2.1%, p = 0.002
  • CV death: 0.8% vs. 1.4%, p = 0.0005

Interpretation:

  • results of this landmark trial indicate that intensive BP lowering to a target <120 mm Hg is superior to routine management with a target of <140 mm Hg in high-risk nondiabetic patients with hypertension, including in elderly patients. There were also reductions noted in CV and all-cause mortality, accompanied by a reduction in CHF. An intensive strategy carried a higher risk of hypotension, syncope, and accelerated reductions in GFR (only in patients without CKD at baseline).

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