More intensive management of
high blood pressure, below a commonly recommended blood pressure target,
significantly reduces rates of cardiovascular disease, and lowers risk of death
in a group of adults 50 years and older with high blood pressure. This is
according to the initial results of a landmark clinical trial sponsored by the
National Institutes of Health called the Systolic Blood Pressure Intervention
Trial (SPRINT). The intervention in this trial, which carefully adjusts the
amount or type of blood pressure medication to achieve a target systolic
pressure of 120 millimeters of mercury (mm Hg), reduced rates of cardiovascular
events, such as heart attack and heart failure, as well as stroke, by almost a
third and the risk of death by almost a quarter, as compared to the target
systolic pressure of 140 mm Hg.
“This study provides potentially lifesaving
information that will be useful to health care providers as they consider the
best treatment options for some of their patients, particularly those over the
age of 50,” said Gary H. Gibbons, M.D., director of the National Heart, Lung,
and Blood Institute (NHLBI), the primary sponsor of SPRINT. “We are delighted
to have achieved this important milestone in the study in advance of the
expected closure date for the SPRINT trial and look forward to quickly
communicating the results to help inform patient care and the future
development of evidence-based clinical guidelines.”
High blood pressure, or
hypertension, is a leading risk factor for heart disease, stroke, kidney
failure, and other health problems. An estimated 1 in 3 people in the United
States has high blood pressure.
The SPRINT study evaluates
the benefits of maintaining a new target for systolic blood pressure, the top
number in a blood pressure reading, among a group of patients 50 years and
older at increased risk for heart disease or who have kidney disease. A
systolic pressure of 120 mm Hg, maintained by this more intensive blood
pressure intervention, could ultimately help save lives among adults age 50 and
older who have a combination of high blood pressure and at least one additional
risk factor for heart disease, the investigators say.
The SPRINT study, which
began in the fall of 2009, includes more than 9,300 participants age 50 and
older, recruited from about 100 medical centers and clinical practices
throughout the United States and Puerto Rico. It is the largest study of its
kind to date to examine how maintaining systolic blood pressure at a lower than
currently recommended level will impact cardiovascular and kidney diseases. NIH
stopped the blood pressure intervention earlier than originally planned in
order to quickly disseminate the significant preliminary results.
The study population was
diverse and included women, racial/ethnic minorities, and the elderly. The
investigators point out that the SPRINT study did not include patients with
diabetes, prior stroke, or polycystic kidney disease, as other research
included those populations.
When SPRINT was designed,
the well-established clinical guidelines recommended a systolic blood pressure
of less than 140 mm Hg for healthy adults and 130 mm Hg for adults with kidney
disease or diabetes. Investigators designed SPRINT to determine the potential
benefits of achieving systolic blood pressure of less than 120 mm Hg for
hypertensive adults 50 years and older who are at risk for developing heart
disease or kidney disease.
Between 2010 and 2013, the
SPRINT investigators randomly divided the study participants into two groups
that differed according to targeted levels of blood pressure control. The
standard group received blood pressure medications to achieve a target of less
than 140 mm Hg. They received an average of two different blood pressure
medications. The intensive treatment group received medications to achieve a
target of less than 120 mm Hg and received an average of three medications.
“Our results provide
important evidence that treating blood pressure to a lower goal in older or
high-risk patients can be beneficial and yield better health results overall,”
said Lawrence Fine, M.D., chief, Clinical Applications and Prevention Branch at
NHLBI. “But patients should talk to their doctor to determine whether this
lower goal is best for their individual care.”
The study is also examining
kidney disease, cognitive function, and dementia among the patients; however,
those results are still under analysis and are not yet available as additional
information will be collected over the next year. The primary results of the
trial will be published within the next few months.
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