SPRINT trial: A lower target blood pressure reduces risk of heart attacks and death

By John Murphy, MDLinx
Published January 13, 2016

Key Takeaways

Intensive blood pressure management can prevent the cardiovascular complications of hypertension and save lives, according to preliminary results from the Systolic Blood Pressure Intervention Trial (SPRINT), a landmark study of older adults with high blood pressure.

“The initial results of the SPRINT trial indicate that careful adjustments in the amount or type of blood pressure medication to achieve a target systolic blood pressure of less than 120 mmHg—rather than the commonly recommended target of 140 mmHg—reduces cardiovascular events by 30%. Moreover, it reduces the risk of death by almost 25%,” said Gary H. Gibbons, MD, director of the National Heart, Lung, and Blood Institute (NHLBI), the primary sponsor of the study.

Dr. Gibbons added, “This new important information has the potential to benefit a portion of the estimated 1 in 3 adults in the United States who suffer from high blood pressure, as well as millions of others worldwide.”

The findings were so convincing that the data and safety monitoring board that oversaw the study called for the trial to be ended prematurely in order to announce the preliminary results as early as possible.

The SPRINT trial, which began in the fall of 2009, includes more than 9,300 participants recruited from about 100 medical centers and clinical practices throughout the U.S. All participants are age 50 and older (mean age 68), and one-fourth are 75 and older. It is the largest study of its kind to examine how maintaining systolic blood pressure at a lower target level than that currently recommended will impact cardiovascular and kidney diseases.

At the time the trial began, and to this day, there hasn’t been a consensus on how much blood pressure should be lowered to reduce the risks of cardiovascular, kidney, and other complications. This trial aimed to answer that question.

To do so, the SPRINT investigators randomly divided the study participants into two groups. The standard group received an average of 2 different blood pressure medications to achieve a target of less than 140 mmHg. The intensive treatment group received an average of 3 medications in order to achieve a target of less than 120 mmHg.

“At the time SPRINT was stopped, the group assigned to a systolic blood pressure of less than 120 mmHg were shown to have a lower composite primary outcome of heart attacks and other forms of acute coronary syndrome, stroke, heart failure, and cardiovascular disease death by 30%,” said principal investigator Jackson T. Wright, Jr, MD, PhD, Professor of Medicine at Case Western Reserve University and Director of the Clinical Hypertension Program at University Hospitals Case Medical Center, in “The intensive intervention also reduced the risk of almost any kind of death by almost a quarter.”

However, Dr. Wright strongly cautioned, these results are preliminary and should not to be taken as guidelines or treatment recommendations. A primary outcome paper will be published by the end of 2015, which may be used to inform the development of evidence-based clinical guidelines.

Specific findings on subgroups—including women, African-Americans, the elderly, and others—will also be released at a later date, after the trial data have been validated.

Another arm of the study, SPRINT MIND, is ongoing. It will test whether the lower systolic blood pressure target will affect dementia cognition, and brain structure as seen on MRI.

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