Let's Not SPRINT to Judgment About New Blood Pressure Goals

Ideas and Opinions17 May 2016Let's Not SPRINT to Judgment About New Blood Pressure GoalsEduardo Ortiz, MD, MPH and Paul A. James, MDEduardo Ortiz, MD, MPHFrom Washington, DC, and University of Iowa, Iowa City, Iowa. and Paul A. James, MDFrom Washington, DC, and University of Iowa, Iowa City, Iowa.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-3123 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail SPRINT (Systolic Blood Pressure Intervention Trial), a randomized, controlled trial that compared aggressive treatment to a target systolic blood pressure (BP) less than 120 mm Hg with a target less than 140 mm Hg in patients at increased cardiovascular risk, was stopped early and its results were promoted widely months before publication (1). Participants were mostly men (64%) with a mean age of 68 years and comorbidities that increased their cardiovascular risk, but patients with diabetes were excluded. With the lower treatment target, the trial found a 25% relative risk reduction in the primary composite outcome. Although a 25% reduction ...References1. Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103-16. [PMID: 26551272] doi:10.1056/NEJMoa1511939 CrossrefMedlineGoogle Scholar2. National Heart, Lung, and Blood Institute. Landmark NIH study shows intensive blood pressure management may save lives [Press release]. Bethesda, MD: National Institutes of Health; 11 September 2015. Accessed at www.nhlbi.nih.gov/news/press-releases/2015/landmark-nih-study-shows-intensive-blood-pressure-management-may-save-lives on 10 December 2015. Google Scholar3. Hensley S. Aggressive lowering of blood pressure carries risks as well as benefits. NPR Health News. 9 November 2015. Accessed at www.npr.org/sections/health-shots/2015/11/09/455344298/aggressive-lowering-of-blood-pressure-carries-risks-as-well-as-benefits on 10 December 2015. Google Scholar4. Supplement to: Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al; SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015. Table S5, p. 33. [PMID: 26551272] doi:10.1056/NEJMoa1511939 Google Scholar5. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507-20. [PMID: 24352797] doi:10.1001/jama.2013.284427 CrossrefMedlineGoogle Scholar6. Welch HG, Schwartz LM, Woloshin S. Overdiagnosed: Making People Sick in the Pursuit of Health. Boston: Beacon Pr Books; 2012. Google Scholar7. Montgomery AA, Fahey T. How do patients' treatment preferences compare with those of clinicians? Qual Health Care. 2001;10 Suppl 1:i39-43. [PMID: 11533437] CrossrefMedlineGoogle Scholar8. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. [Editorial]. BMJ. 1996;312:71-2. [PMID: 8555924] CrossrefMedlineGoogle Scholar9. Institute of Medicine. Clinical Practice Guidelines We Can Trust. Washington, DC: National Academies Pr; 2011. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Washington, DC, and University of Iowa, Iowa City, Iowa.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-3123.Corresponding Author: Paul A. James, MD, University of Iowa, 200 Hawkins Drive, 01286-D PFP, Iowa City, IA 52242; e-mail, [email protected]edu.Current Author Addresses: Dr. James: University of Iowa, 200 Hawkins Drive, 01286-D PFP, Iowa City, IA 52242.Dr. Ortiz: 2318 Mill Road, Suite 800, Alexandria, VA 22314; e-mail, [email protected].Author Contributions: Conception and design: E. Ortiz, P.A. James.Analysis and interpretation of the data: E. Ortiz, P.A. James.Drafting of the article: E. Ortiz, P.A. James.Critical revision for important intellectual content: E. Ortiz, P.A. James.Final approval of the article: E. Ortiz, P.A. James.Statistical expertise: E. Ortiz, P.A. James.Administrative, technical, or logistic support: E. Ortiz, P.A. James.Collection and assembly of data: E. Ortiz, P.A. James.This article was published at www.annals.org on 23 February 2016. 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A Randomized Trial of Intensive versus Standard Blood‐Pressure Control»Comentário a: «The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood‐Pressure Control»Management of Hypertension: JNC 8 and BeyondShould We SPRINT Toward New Blood Pressure Goals or Let the Dust Settle?Treatment of hypertension and the price to pay; adverse events and discontinuation from randomized treatment in clinical trials 17 May 2016Volume 164, Issue 10Page: 692-693KeywordsAbsolute risk reductionAcute renal failureAdverse reactionsBlood pressureConflicts of interestDecision makingDrugsRandomized trialsRelative riskSystolic pressure ePublished: 23 February 2016 Issue Published: 17 May 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...