ORLANDO – SPRINT’s hypertension-treatment results serve as a rebuttal to the systolic blood pressure target of less than 150 mm Hg for older patients set less than 2 years ago by the panel originally constituted as JNC 8, Dr. Prakash Deedwania said in an interview at the American Heart Association scientific sessions.
“We were all concerned” by the high target systolic blood pressure for patients aged 60 years or older set by the panel initially organized as JNC 8, said Dr. Deedwania, professor of medicine at the University of California, San Francisco, in Fresno. The SPRINT results, which showed incremental value for a systolic blood pressure target of less than 120 mm Hg for selected patients at risk for cardiovascular disease, will influence the new hypertension-treatment guidelines now in development by a panel formed by the American College of Cardiology and American Heart Association, he said.
While applauding SPRINT (Systolic Blood Pressure Intervention Trial) and its clear outcome, Dr. Deedwania cited several cautions to keep in mind when applying the results to practice. One of his concerns centered on driving diastolic pressure low with aggressive antihypertensive treatment, especially in elderly patients with underlying coronary artery disease who could have inadequate coronary perfusion if their diastolic pressure drops too low.
Another caution was the need to reconcile the SPRINT results with those from the ACCORD blood pressure trial results, which failed to show that a systolic blood pressure target of less than 120 mm Hg led to better outcomes than did a target of less than 140 mm Hg in patients with diabetes. Although SPRINT specifically excluded patients with diabetes, a helpful analysis that the SPRINT data should allow is assessment of outcomes in patients who were obese and had hyperlipidemia as well as hypertension, defining a subgroup of patients with metabolic syndrome that is considered a prediabetes state.
Dr. Deedwania also warned that so far researchers have not reported the SPRINT results in patients with preexisting renal dysfunction compared with patients with more normal kidney function. Patients with impaired renal function can be in jeopardy if their blood pressure gets too low, he noted.
Dr. Deedwania had no disclosures.