Contents

Search

Sprint study

Study characteristics: - 9400 patients age >=50 years - systolic BP of 130-180 mm Hg - high cardiovascular risk - no history of diabetes mellitus or stroke - trial terminated early after a median follow-up of 3.3 years due to questions about trial design & how the results should be applied [13] - subgroup 2: 2600 adults >= 75 years with increased CV risk Treatment: - target systolic blood pressure 120 mm Hg vs 140 mm Hg - antihypertensive(s) chosen at discretion of provider Results: - average systolic BPs were 121.5 mm Hg for target of 120 mm Hg vs 134.6 mm Hg for target of 140 mm Hg - primary outcome (MI, acute coronary syndrome, stroke, heart failure, or CV-related death) occurred in 5.2% of 120 mm Hg target group vs 6.8% of 140 mm Hg target group - number needed to treat: 62 for 3.2 years to prevent 1 event [7] - number needed to harm: 45 for 3.2 years to cause 1 adverse event [7] - target of 120 mm Hg vs 140 mm Hg lowered risk of - heart failure (1.3% vs 2.1%) - CV-related death (0.8% vs. 1.4%)* - all-cause mortality (3.3% vs. 4.5%)* - serious adverse events were significantly more common with target of 120 mm Hg vs 140 mm Hg - incidences of hypotension, syncope, & electrolyte imbalances ~ 1% higher - greater time in the target systolic range predicted a lower risk of major cardiovascular events [20] - incidence of acute kidney injury ~2% higher - SPRINT investigators claim that a hemodynamic effect, rather than a true kidney damage effect accounts for the decline in GFR [10] - subgroup of patients >= 75 years - absolute risk reduction for cardiovascular events & mortality = 3.5% (NNT = 28) - mobility unaffected by lower target blood pressure in subgroup > 75 years of age [5] - in subgroup >= 60 years intensive BP control reduced risk of heart failure & cardiovascular death, but increased risk of hypotension, syncope, & acute renal failure [23] - adding an antihypertensive from a new class resulted in reduction in mean systolic BP (- 14 mm Hg) [9] & major cardiovascular events (- 6.6 per 1000 patient years) - similar reductions in systolic BP regardless of whether patients were taking 1,2,3 or 4 classes of antihypertensives [9] - adding a new class of hypertensive not associated with increase in adverse effects [9] - SPRINT BP targets increase cardiovascular risk in smokers [12] - patients at high cardiovascular risk may gain 6 months to 3 years in life expectancy from intensive blood pressure treatment [14] - low diastolic BP is associated with adverse cardiovascular events [21] - increased mortality from intensive BP therapy vs standard therapy when diastolic BP is low: RR=1.8 for 50 mm Hg vs RR=0.77 for 80 mm Hg [21] - compared with a standard blood pressure target (SBP < 140 mm Hg), an intensive blood pressure target (SBP < 120 mm Hg) is associated with increased, rather than decreased, cerebral perfusion [22] * no explanation is provided; what did they die of? Notes: - 8% of adults eligible for tighter blood pressure control by SPRINT criteria [2] - at baseline, mean BP was 138/77 mm Hg [16] - mean systolic BP 6 mm Hg lower at SPRINT visits than in routine practice [16] - Korean study finds RR=1.17 for utilization of JNC8 goals vs SPRINT goals [4] - two trials (ONTARGET & TRANSCEND trials) report that lowering systolic BP <120 mm Hg is associated with greater CV-related & all-cause mortality [6] - SPRINT group reports reduction in mild cognitive impairment, but not dementia using SPRINT goals (14.6 vs 18.3 per 1000 person-years) [11] - small but statistically significantly lower amount of white matter lesions & a slightly greater decrease in brain volume [13] - 4.57-5.49 vs 5.85 uL over 4 years, mean age 67, median Montreal Cognitive Assessment score was 24. - no significant change in total brain volume [13] - pattern hypertension at midlife with low blood pressure in late-life confounds findings - obvious issue of adequate perfusion pressure sensed by carotid sinus - mean standardized memory domain scores & mean standardized processing speed declined more with SPRINT group than with targeting systolic BP to 140 mm Hg but difference not clinically significant [15] - intensive blood pressure control (target systolic BP < 120 mm Hg vs < 140 mm Hg) did not reduce brain MRI markers of Alzheimer's disease [18] - racial disparities in hypertension control & associated cardiovascular risk may not be predominantly associated with genetic factors, but more likely driven by extrinsic, societal factors [17] - intensive systolic BP control reduces combined risk of mild cognitive impairment or dementia to a greater degree in persons at higher risk [24]

Related

Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial

General

hypertension clinical trials

References

  1. The Sprint Research Group A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. Nov 9, 2015 PMID: 26551272 http://www.nejm.org/doi/full/10.1056/NEJMoa1511939 - Drazen JM et al A SPRINT to the Finish. N Engl J Med. Nov 9, 2015 PMID: 26551058 http://www.nejm.org/doi/full/10.1056/NEJMe1513991 - Perkovic V, Rodgers A Redefining Blood-Pressure Targets - SPRINT Starts the Marathon. N Engl J Med. Nov 9, 2015 PMID: 26551394 http://www.nejm.org/doi/full/10.1056/NEJMe1513301 - Chobanian AV Time to Reassess Blood-Pressure Goals. N Engl J Med. November 9, 2015 PMID: 26550920 http://www.nejm.org/doi/full/10.1056/NEJMp1513290
  2. Bress AP, Tanner RM, Hess R et al Generalizability of results from the Systolic Blood Pressure Intervention Trial (SPRINT) to the US adult population. J Am Coll Cardiol. 2015;() PMID: 26562046 https://mail.google.com/mail/u/0/?tab=wm#inbox/150edbd5376db391
  3. Williamson JD et al Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged >= 75 Years. A Randomized Clinical Trial. JAMA. Published online May 19, 2016 PMID: 27195814 http://jama.jamanetwork.com/article.aspx?articleid=2524266 - Chobanian AV SPRINT Results in Older Patients. How Low to Go? JAMA. Published online May 19, 2016 PMID: 27195462 http://jama.jamanetwork.com/article.aspx?articleid=2524265
  4. Ko MJ et al. Level of blood pressure control and cardiovascular events: SPRINT criteria versus the 2014 hypertension recommendations. J Am Coll Cardiol 2016 Jun 21; 67:2821. PMID: 27311520 - Whelton PK and Muntner P. Potential implications of the systolic blood pressure intervention trial in Korea. J Am Coll Cardiol 2016 Jun 21; 67:2832. PMID: 27311521
  5. Odden MC, Peralta CA, Berlowitz DR Effect of Intensive Blood Pressure Control on Gait Speed and Mobility Limitation in Adults 75 Years or Older. A Randomized Clinical Trial. JAMA Intern Med. Published online February 6, 2017 PMID: 2816632 http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2601080
  6. Bohm M et al. Achieved blood pressure and cardiovascular outcomes in high- risk patients: Results from ONTARGET and TRANSCEND trials. Lancet 2017 Apr 5 PMID: 28390695 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30754-7/fulltext
  7. Husten L AHA: BP Measurement in SPRINT Was All Over the Place Did varying presence of staff during BP readings ruin a huge study? CardioBrief. MedPage Today. Nov 14, 2017. https://www.medpagetoday.com/meetingcoverage/aha/69284 - Husten L Cardiologists: Thumbs Down To SPRINT - SPRINT should not be used in guidelines to lower blood pressure targets. CardioBrief. MedPage Today. Aug, 28, 2016. http://www.cardiobrief.org/2016/08/28/cardiologists-thumbs-down-to-sprint/
  8. Ortiz E, James PA Let's Not SPRINT to Judgment About New Blood Pressure Goals. Ann Intern Med. 2016;164(10):692-693. PMID: 26902415 http://annals.org/aim/article-abstract/2494542/let-s-sprint-judgment-about-new-blood-pressure-goals
  9. Markovitz AA, Mack JA, Nallamothu BK, Ayanian JZ, Ryan AM. Incremental effects of antihypertensive drugs: Instrumental variable analysis. BMJ 2017 Dec 22; 359:j5542 PMID: 29273586 Free PMC Article http://www.bmj.com/content/359/bmj.j5542
  10. Zhang WR, Craven TE, Malhotra R et al Kidney Damage Biomarkers and Incident Chronic Kidney Disease During Blood Pressure Reduction: A Case-Control Study. Ann Intern Med. 2018 Oct 23. PMID: 30357395
  11. The SPRINT MIND Investigators for the SPRINT Research Group Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia. A Randomized Clinical Trial. JAMA. Published online January 28, 2019 PMID: 30688979 https://jamanetwork.com/journals/jama/fullarticle/2723256 - Yaffe K Prevention of Cognitive Impairment With Intensive Systolic Blood Pressure Control. JAMA. Published online January 28, 2019 PMID: 30688980 https://jamanetwork.com/journals/jama/fullarticle/2723255
  12. Boyles S, SPRINT Re-Analysis Has News for Smokers With Hypertension. Outcomes worse with aggressive blood pressure targets. MedPage Today. March 08, 2019. https://www.medpagetoday.com/cardiology/hypertension/78460 - Scarpa J, et al Assessment of risk of harm associated with intensive blood pressure management among patients with hypertension who smoke. JAMA Net Open 2019 Not indexed in PubMed https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2727263
  13. George J Studies Tackle Blood Pressure, Cognition Relationship - SPRINT MIND looks at white matter lesions; ARIC assesses dementia risk. MedPage Today. August 13, 2019 https://www.medpagetoday.com/neurology/dementia/81580 - SPRINT MIND Investigators for the SPRINT Research Group. Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions JAMA. 2019 Aug 13;322(6):524-534 PMID: 31408137 https://jamanetwork.com/journals/jama/fullarticle/2747671 - Walker KA, Sharrett AR, Wu A et al Association of Midlife to Late-Life Blood Pressure Patterns With Incident Dementia. JAMA. 2019 Aug 13;322(6):535-545. PMID: 31408138 https://jamanetwork.com/journals/jama/fullarticle/2747672 - Prabhakaran S Blood Pressure, Brain Volume and White Matter Hyperintensities, and Dementia Risk. JAMA. 2019;322(6):512-513. PMID: 31408120 https://jamanetwork.com/journals/jama/fullarticle/2747651
  14. Vaduganathan M, Claggett BL, Juraschek SP et al Assessment of Long-term Benefit of Intensive Blood Pressure Control on Residual Life SpanSecondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). JAMA Cardiol. Feb 26, 2020 PMID: 32101262 https://jamanetwork.com/journals/jamacardiology/fullarticle/2761951
  15. George J No Difference in Memory, Processing Speed With Tight BP Control - SPRINT substudy looks at effects on specific cognitive domains. MedPage Today October 27, 2020 https://www.medpagetoday.com/neurology/dementia/89360
  16. Drawz PE et al. Concordance between blood pressure in the systolic blood pressure intervention trial and in routine clinical practice. JAMA Intern Med 2020 Oct 12; [e-pub] PMID: 33044494 PMCID: PMC7551238 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2771670
  17. Lou N SPRINT: African Ancestry Not an Innate CVD Risk in Blacks - Study refutes genetic basis for racial disparities in hypertension, CVD. MedPage Today November 13, 2020 https://www.medpagetoday.com/meetingcoverage/aha/89644 - Rao S, et al Association of genetic West African ancestry, blood pressure response to therapy, and cardiovascular risk among self-reported black individuals in the Systolic Blood Pressure Reduction Intervention Trial. JAMA Cardiol 2020. Nov 13. PMID: 33185651 https://jamanetwork.com/journals/jamacardiology/fullarticle/10.1001/jamacardio.2020.6566 - Powell-Wiley TM Disentangling ancestry from social determinants of health in hypertension disparities -- an important step forward. JAMA Cardiol 2020. Nov 13 PMID: 33185656 https://jamanetwork.com/journals/jamacardiology/fullarticle/10.1001/jamacardio.2020.6576
  18. Nasrallah IM, Gaussoin SA, Pomponio R et al. Association of intensive vs standard blood pressure control with magnetic resonance imaging biomarkers of Alzheimer disease: Secondary analysis of the SPRINT MIND randomized trial. JAMA Neurol 2021 Mar 8; [e-pub]. PMID: 33683313 PMCID: PMC7941253 (available on 2022-03-08) https://jamanetwork.com/journals/jamaneurology/article-abstract/2776960
  19. Lewis CE et al. Final report of a trial of intensive versus standard blood-pressure control. N Engl J Med 2021 May 20; 384:1921 PMID: 34010531 https://www.nejm.org/doi/10.1056/NEJMoa1901281
  20. Bakris G, Sternlicht H Time in Therapeutic Range: Redefining "Optimal" Blood Pressure Control. J Am Coll Cardiol. 2021;77(10):1300-1301. PMID: 33706871 PMCID: PMC8091295 Free PMC article https://www.medscape.com/viewarticle/951861 - Fatani N, Dixon DL, Van Tassell, Fanikos J, Buckley LF Systolic Blood Pressure Time in Target Range and Cardiovascular Outcomes in Patients With Hypertension. J Am Coll Cardiol. 2021 Mar 16;77(10):1290-1299 PMID: 33706870 PMCID: PMC7959178 (available on 2022-03-16)
  21. Foy AJ, Filippone EJ, Schaefer E et al Association Between Baseline Diastolic Blood Pressure and the Efficacy of Intensive vs Standard Blood Pressure-Lowering Therapy. JAMA Netw Open. 2021;4(10):e2128980. October 20 PMID: 34668944 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785309
  22. Dolui,S, Detre JA; Gaussoin SA et al Association of Intensive vs Standard Blood Pressure Control With Cerebral Blood Flow.Secondary Analysis of the SPRINT MIND Randomized Clinical Trial .JAMA Neurol. 2022;79(4):380-389. PMID: 35254390 PMCID: PMC8902686 (available on 2023-03-07) https://jamanetwork.com/journals/jamaneurology/fullarticle/2789504
  23. Cheema MF, Butt Z, Gilani S et al Intensive Blood Pressure Control and Cardiovascular Outcomes in Elderly Patients: A Secondary Analysis of SPRINT Study Based on a 60-Year Age Cutoff. Am J Hypertens. 2023 April 27 PMID: 37105717 https://academic.oup.com/ajh/advance-article-abstract/doi/10.1093/ajh/hpad039/7146182
  24. Ghazi L, Shen J, Ying J et al Identifying Patients for Intensive Blood Pressure Treatment Based on Cognitive Benefit. A Secondary Analysis of the SPRINT Randomized Clinical Trial. JAMA Netw Open. 2023;6(5):e2314443 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2805026