Final SPRINT Data Confirm Benefits of Intensive BP Lowering

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Final results from the Systolic Blood Pressure Intervention Trial (SPRINT) support an intensive strategy targeting a systolic blood pressure (BP) of less than 120 mm Hg, reports The New England Journal of Medicine.

The analysis included patients, aged 50 years or older, with baseline systolic BP of 130 to 8 mm Hg and increased risk for cardiovascular disease, but without diabetes or a history of stroke. Patients were randomly assigned to intensive or standard treatment, with systolic BP targets of less than 120 or 140 mm Hg, respectively. The study was halted early in 2015—at a median follow-up of 3.33 years—due to overwhelming evidence of benefit in the intensive-treatment group. The current report presents final outcomes at a median 3.88 years' follow-up, including data from study close-out visits.

In the initial 2015 report, rates of a primary composite outcome of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or cardiovascular death were 1.77% per year with the intensive-treatment strategy versus 2.40% per year with standard treatment: hazard ratio (HR) 0.73. All-cause mortality was 1.06% versus 1.41% per year: HR 0.75. Intensive treatment was associated with higher rates of some serious adverse events, including hypotension, electrolyte abnormalities, acute kidney injury or kidney failure, and syncope.

On analysis of the combined intervention and postintervention results, rates of both the primary outcome and all-cause mortality were lower with intensive treatment: HR 0.76 and 0.79, respectively. The lower systolic BP target remained associated with lower rates of myocardial infarction and cardiovascular death, although rates of heart failure events no longer differed significantly between groups.

Hypotension, electrolyte abnormalities, and acute kidney injury or kidney failure remained more common in the intensive-treatment group. Most kidney adverse events were solitary, mild, and followed by recovery of kidney function.

The final SPRINT results confirm significant reductions in major adverse cardiovascular events and all-cause mortality with intensive BP-lowering treatment targeting a systolic BP of less than 120 mm Hg. Some adverse events continue to be more frequent in the intensive-therapy group [SPRINT Research Group, et al. Final report of intensive versus standard blood-pressure control. N Engl J Med 2021; 384:1921–1930. doi: 10.1056/NEJMoa1901281].