AHA.15: Results of SPRINT trial may change systolic blood pressure target goals

The release of the full results of the SPRINT (Systolic Blood Pressure Intervention Trial) study on Nov. 9 may lead cardiologists to re-consider the ideal blood pressure goals for some patients.

As of now, guidelines suggest 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, the SPRINT trial found that decreasing the systolic blood pressure target to less than 120 mm Hg led to significantly lower relative risks of heart failure, death from cardiovascular causes and death from any cause.

The randomized, controlled, open-label trial enrolled 9,361 adults at 102 sites in the U.S. who were at least 50 and had an increased risk of cardiovascular events. It excluded adults with diabetes, prior stroke or polycystic kidney disease.

Study results were presented at the American Heart Association (AHA) Scientific Sessions and simultaneously published online in the New England Journal of Medicine.

“The SPRINT study will certainly be something that the current guideline process will consider,” Daniel Jones, MD, of the University of Mississippi Medical Center, said in a news conference at the AHA meeting in Orlando. “I think we can anticipate a strong consideration of change in the blood pressure goal between now and when the new guidelines are available. 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."

Aram V. Chobanian, MD, of Boston University Medical Center, wrote in the New England Journal of Medicine that the results of the SPRINT trial did not apply for patients with diabetes, a history of stroke or institutionalized elderly people. However, he wrote that results suggest lowering the systolic blood pressure goal to treat hypertension to less than 130 mm Hg in most people with hypertension who are older than 50 and do not have diabetes or a history of stroke.

Still, he mentioned that one-third to one-half of people in the U.S. have blood pressure higher than the current standard of 140/90 mm Hg.

“If the systolic blood-pressure goal were 130 mm Hg or even 120 mm Hg, the majority of people with hypertension in the United States would be considered to have uncontrolled blood pressure now,” Chobanian wrote. “In addition, in the SPRINT intensive-treatment group, an average of three different antihypertensive drugs was required, and still the 120 mm Hg goal was not reached in some. Currently, many clinicians and their patients with hypertension are reluctant to go beyond two different antihypertensive drugs, and adherence to therapy suffers with increasing complexity of clinical regimens.”

Paul K. Whelton, MD, chairman of the SPRINT steering committee, said at a news conference that the systolic blood pressure guidelines have been lowered from less than 165 mm Hg to less than 140 mm Hg since he began practicing medicine. When they were decreased to less than 140 mm Hg, only a small percentage of people met that threshold, but now approximately 50 percent of the U.S. population has achieved the goal of less than 140 mm Hg.

“We are doing progressively better,” Whelton said. “I’m confident we can continue to move that percentage up for the 140 [mm Hg goal] and if guidelines decide the goal should be lower, I’m confident we can do it.”