In all, 1,793 participants in the intensive-treatment group (38.3%) and 1,736 participants in the standard-treatment group (37.1%) had a serious adverse event. The hazard ratio of serious adverse events was 1.04 for the intensive-treatment group. Events such as hypotension, syncope, electrolyte abnormalities, and acute kidney injury or acute renal failure were more common in the intensive-treatment group than in the standard-treatment group. Orthostatic hypotension was significantly less common in the intensive-treatment group.
The intensive-treatment group in SPRINT had a nonsignificant 11% lower incidence of stroke. For comparison, treatment to an intensive systolic blood pressure goal of less than 130 mm Hg was associated with a nonsignificant 19% lower incidence of stroke in the Secondary Prevention of Small Subcortical Strokes trial, compared with treatment to higher targets. Treatment to an intensive systolic blood pressure goal of less than 120 mm Hg was associated with a significant 41% lower incidence of stroke in the ACCORD trial.
“Among adults with hypertension but without diabetes, lowering systolic blood pressure to a target goal of less than 120 mm Hg, as compared with the standard goal of less than 140 mm Hg, resulted in significantly lower rates of fatal and nonfatal cardiovascular events and death from any cause,” said Dr. Wright.
Ramifications for Future Guidelines
“A goal for systolic blood pressure of less than 150 mm Hg now seems too high for most elderly patients, and a more aggressive approach appears warranted for those with cardiovascular disease or at high risk for it,” said Aram V. Chobanian, MD, Professor of Medicine at Boston University School of Medicine, in an accompanying editorial. A goal for systolic blood pressure of less than 120 mm Hg may be inappropriate for most people with hypertension, however, because many participants in the SPRINT intensive-treatment group did not reach their target blood pressure, he added. “The results from SPRINT warrant reducing the treatment goal for systolic blood pressure to less than 130 mm Hg in most people with hypertension who are over 50 years of age and do not have diabetes or a history of stroke.”
Reaching stricter blood pressure goals likely will require more careful titration of medications, greater use of combination drug preparations, more monitoring for adverse effects, and more frequent patient visits, said Dr. Chobanian.
An analysis published online ahead of print November 9 in Journal of the American College of Cardiology found that if guidelines were to be based on the SPRINT results, more than 16.8 million Americans could be recommended for intensive blood pressure management. African Americans and Hispanics are less likely to meet SPRINT eligibility criteria, compared with Caucasians, largely because the minority populations have a higher prevalence of diabetes and other health conditions. Men are more likely to meet SPRINT eligibility criteria than women, partly because women tend not to have increased risk for cardiovascular disease until they are older than 65.
—Erik Greb