Final SPRINT results confirm aggressive BP target reduces risk for MI, HF, CVD death
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Lowering systolic BP to less than 120 mm Hg significantly reduced risk for MI, HF and CVD death compared with a systolic BP of less than 140 mm Hg, according to the final results of the SPRINT trial.
“One criticism of the original SPRINT findings was that, of the components of the primary outcome, only heart failure and death due to CVD were significantly lower in the intensively treated group,” Cora E. Lewis, MD, MSPH, professor and chair of the department of epidemiology at the University of Alabama Birmingham School of Public Health, said in a press release. “The final results found that risk of heart attack, along with heart failure, and death from CVD, was significantly lower in the group treated to less than 120, and the risk of the primary outcome excluding heart failure was still significantly lower in the more intensively treated group.”
Healio previously covered the SPRINT trial, published in The New England Journal of Medicine, in which 9,361 participants at increased CVD risk without diabetes or previous stroke were randomly assigned to adhere to a treatment program to achieve an aggressive systolic BP target of less than 120 mm Hg or to a standard treatment with to achieve a target of systolic BP less than 140 mm Hg. This trial found that those in the intensive treatment group demonstrated lower rates of the primary outcome of MI, other ACS, stroke, HF and death from CV causes, as well as lower rates of all-cause mortality, compared with the standard treatment group.
In the final SPRINT results, based on a median of 3.33 years follow-up, the rate of the primary outcome was 1.77% per year in the intensive treatment group compared with 2.4% per year in the standard treatment group (HR = 0.73; 95% CI, 0.63-0.86).
All-cause mortality was also significantly reduced in the intensive treatment group compared with the standard treatment group (1.06% vs. 1.41% per year; HR = 0.75; 95% CI, 0.61-0.92).
Serious adverse events, including hypotension (0.7% vs. 0.4% per year), electrolyte abnormalities (0.9% vs. 0.7% per year), acute kidney injury or failure (1.3% vs. 0.8% per year) and syncope (0.6% vs. 0.5% per year), occurred significantly more frequently among the intensive treatment group compared with the standard treatment group, according to the researchers.
Researchers observed similar patterns in treatment benefit and serious adverse events when trial and post-trial follow-up data were combined (median follow-up, 3.88 years), but HF rates were no longer different between the intensive treatment and standard treatment groups.
“As we implement what we know, more research is still needed to develop more effective prevention strategies for hypertension, improve its monitoring and control, and reduce the large health disparities associated with this disorder,” David Goff, MD, PhD, director of the division of cardiovascular sciences at NHLBI, said in the release. “Research teams supported by the NIH are continuing to work on these challenges.”
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