Will SPRINT trial results change practice?

On Sept. 11, the National Institutes of Health (NIH) released preliminary results of a landmark trial that found lowering the systolic blood pressure target below the currently recommended level led to large reductions in heart failure, MI and the risk of death in older adults who had high blood pressure but not diabetes. The results were so impressive that the researchers stopped the study early because the benefits were clear.

The findings of the SPRINT (Systolic Blood Pressure Intervention Trial) study received national attention, although the NIH did not provide many details. After the full results were presented on Nov. 9 at the American Heart Association (AHA) Scientific Sessions and simultaneously published online in the New England Journal of Medicine, the question remains whether they will change practice.

Current guidelines recommend a systolic blood pressure of less than 140 mm Hg for healthy adults and 130 mm Hg for adults with kidney disease or diabetes.

However, patients in the SPRINT trial who had a systolic blood pressure target of less than 120 mm Hg had a 25 percent lower relative risk of the primary composite outcome of MI, other acute coronary syndromes, stroke, heart failure or death from cardiovascular causes compared with those who had a target of less than 140 mm Hg. The intensive group also had a 38 percent lower relative risk of heart failure, 43 percent lower relative risk of death from cardiovascular causes and 27 percent lower relative lower risk of death from any cause.

Researchers in the SPRINT trial and others within the cardiovascular community said the findings will be studied when new guidelines are written in the coming years. They also noted that the study was limited to participants who were at least 50, had a systolic blood pressure of between 130 mm Hg and 180 mm Hg and an increased risk of cardiovascular events. Adults with diabetes, prior stroke or polycystic kidney disease were excluded.

“I think we can anticipate a strong consideration of change in the blood pressure goal between now and when the new guidelines are available,” Daniel Jones, MD, of the University of Mississippi Medical Center, said in a news conference at the AHA meeting in Orlando. “I think you can expect many clinicians will look at the results of the SPRINT trial and will move forward with making decisions on many of their patients, especially those at high risk, for more aggressive lowering of blood pressure.”

If the guidelines recommend lowering the systolic blood pressure goals, one potential issue may be convincing patients to take more medications. In the SPRINT study, the mean number of blood pressure medications was 2.8 in the intensive group and 1.8 in the standard group.

“I think [the results are] certainly going to shift my approach, but it’s hard enough to get people to be on antihypertensives as is,” Marc A. Pfeffer, MD, of Brigham & Women’s hospital in Boston, said at a news conference. “That’s why I was stressing the doctor isn’t going to get a thank you, the patient isn’t going to say ‘Another medicine?’ because that makes people feel they’re sicker than they were. We need a lot of education here, but I think if we do that, we’ll be lowering cardiovascular morbidity [and] mortality.”

Tim Casey
Executive Editor