MENU ▼
Read by QxMD icon Read
search
OPEN IN READ APP
COMPARATIVE STUDY
JOURNAL ARTICLE
MULTICENTER STUDY
RANDOMIZED CONTROLLED TRIAL

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
26551272

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; ClinicalTrials.gov number, NCT01206062.).

Comments

You need to log in or sign up for an account to be able to comment.

Daniel Schwartz wrote:

16

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"
http://www.nhlbi.nih.gov/news/press-releases/2015/landmark-nih-study-shows-intensive-blood-pressure-management-may-save-lives

NEJM's blog post: "SPRINTing Towards a Lower Blood Pressure Target"
http://blogs.nejm.org/now/index.php/blood-pressure-control-sprinting-towards-a-lower-blood-pressure-target/2015/11/09/

NEJM Editorial by Vlado Perkovic and Anthony Rodgers, "Redefining Blood-Pressure Targets — SPRINT Starts the Marathon"
http://www.qxmd.com/r/26551394

NEJM Perspective by Aram Chobanian, "Time to Reassess Blood-Pressure Goals"
http://www.qxmd.com/r/26550920

New York TImes reports "Lower Blood Pressure Guidelines Could Be ‘Lifesaving,’ Federal Study Says"
http://www.nytimes.com/2015/09/12/health/blood-pressure-study.html

Modern Healthcare writes: "SPRINT trial shows benefits of aggressive blood-pressure management"
http://www.modernhealthcare.com/article/20151109/NEWS/151109897

Paul Leach wrote:

13

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 wrote:

6

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 wrote:

2

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

Dwarka Rathi wrote:

2

I think slow gradual lowering of Blood pressure to 120 systolic is the key in my opinion.
it may be over months to years for SBP of 180-190 to 120 is safe in my practice. have not seen any untoward effect

Dwarka Rathi

Related Papers

Available on the App Store

Available on the Play Store

Read Institutional Edition
Remove bar
Read by QxMD icon Read
26551272
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"