A Tale of 3 Trials: ACCORD, SPRINT, and SPS3. What Happened?

Within the last several years, the National Institutes of Health has supported three randomized clinical trials to determine whether lower than usually recommended goals for treatment of hypertension would have greater benefit for prevention of cardiovascular disease and stroke. These were the ACCCORD, SPRINT, and Secondary Prevention of Small Subcortical Strokes (SPS3) Trials. Together they enrolled 17,114 participants. Results for all three have been reported. The trials differ from each other in their inclusion criteria, target blood pressures for the lower goal (intensive treatment), but are similar in many respects. The results with regard to their primary outcome were different: not significant for ACCORD and SPS3, but definitely significant for SPRINT. Subgroup analysis revealed differences and similarities. When viewed together and with recent large observational studies, they support a conclusion that a systolic pressure in the range of 125-135 mm Hg range is likely to be optimal on treatment for most hypertensive patients.