A Randomized Trial of Intensive versus Standard Blood-Pressure Control

Jackson T Wright, Jeff D Williamson, Paul K Whelton, Joni K Snyder, Kaycee M Sink, Michael V Rocco, David M Reboussin, Mahboob Rahman, Suzanne Oparil, Cora E Lewis, Paul L Kimmel, Karen C Johnson, David C Goff, Lawrence J Fine, Jeffrey A Cutler, William C Cushman, Alfred K Cheung, Walter T Ambrosius
New England Journal of Medicine 2015 November 26, 373 (22): 2103-16

BACKGROUND: The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain.

METHODS: We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes.

RESULTS: At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs. 2.19% per year; hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001). All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensive-treatment group than in the standard-treatment group.

CONCLUSIONS: Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. (Funded by the National Institutes of Health; number, NCT01206062.).

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Daniel Schwartz

The world has a lot to say about the SPRINT study (including far too many SPRINT puns)

Here's the NIH press release: "Landmark NIH study shows intensive blood pressure management may save lives"

NEJM's blog post: "SPRINTing Towards a Lower Blood Pressure Target"

NEJM Editorial by Vlado Perkovic and Anthony Rodgers, "Redefining Blood-Pressure Targets — SPRINT Starts the Marathon"

NEJM Perspective by Aram Chobanian, "Time to Reassess Blood-Pressure Goals"

New York TImes reports "Lower Blood Pressure Guidelines Could Be ‘Lifesaving,’ Federal Study Says"

Modern Healthcare writes: "SPRINT trial shows benefits of aggressive blood-pressure management"


Paul Leach

Disappointed by the lack of access to this article. The abstract shows its outcomes in relative risk reductions, which may be misleading. Some patients may not want more aggressive lowering of BP, if it means for example that they cannot drive because they are having syncopal episodes. Also the follow up period is only over 3.26 years. As patients age will their risk of complications from aggressive treatment of hypertension lead to more complications?


G.Andrei Dan

This problem is " revisited". Several years before the 120 mmHg target was rejected because of the lack of evidence from the studies and because of the J curve phenomenon. Now SPRINT give us a new insight into problem. However this is not enough to change the guidelines...not yet...we need more arguments balancing risks and benefits, costs and delineating the optimal target population.


Jacobo Bassan

I agree with with the above study. I have not have any complications or problems with these BP control parameters for past 50 years; my colleague have more C-V complications with more liberal BP control


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