SPRINT issues final report finding fewer cardiovascular events with intensive blood pressure control
Patients treated to a systolic blood pressure target less than 120 mm Hg instead of less than 140 mm Hg had lower rates of cardiovascular events but more incidence of some adverse events, according to new follow-up data.
Targeting a systolic blood pressure of less than 120 mm Hg in patients at increased cardiovascular risk resulted in fewer major adverse cardiovascular events and lower all-cause mortality than a target of less than 140 mm Hg, according to the final report of a major study.
The Systolic Blood Pressure Intervention Trial (SPRINT) randomly assigned 9,361 participants at increased risk for cardiovascular disease but did not have diabetes or previous stroke to an intensive treatment target of systolic blood pressure less than 120 mm Hg or a standard treatment target of less than 140 mm Hg. The primary outcome was a composite of myocardial infarction, other acute coronary syndromes, stroke, acute decompensated heart failure, or death from cardiovascular causes. The final report considered additional primary outcome events occurring through the end of the intervention period of Aug. 20, 2015, as well as analyzed post-trial observational follow-up data through July 29, 2016. Results appeared May 20 at the New England Journal of Medicine.
At a median of 3.33 years of follow-up, the intensive group had a lower rate of both the primary outcome (1.77% per year vs. 2.40% per year; hazard ratio [HR], 0.73; 95% CI, 0.63 to 0.86) and all-cause mortality (1.06% per year vs. 1.41% per year; HR, 0.75; 95% CI, 0.61 to 0.92). Serious adverse events of hypotension, electrolyte abnormalities, acute kidney injury or failure, and syncope were significantly more frequent in the intensive-treatment group than the standard group. When trial and post-trial follow-up data were combined (3.88 years in total), similar patterns were found for treatment benefit and adverse events. However, rates of heart failure no longer differed between the groups.
“During a post-trial observational period, the achieved blood-pressure differential between the treatment groups was attenuated, and more frequent heart failure was noted in the intensive-treatment group,” the authors said. “The updated findings from the intervention period in our trial confirm the significant benefits of intensive blood-pressure control for the primary composite outcome, the components of the primary outcome (myocardial infarction, heart failure, and death from cardiovascular causes), a post hoc composite outcome that excluded heart failure, and all-cause mortality.”