Why the study?
Does an intensive systolic blood pressure target of 120 mmHg reduce cardiovascular disease risk and mortality in older adults compared to a standard target of 140 mmHg?
Does an intensive systolic blood pressure target of 120 mmHg reduce cardiovascular disease risk and mortality in older adults compared to a standard target of 140 mmHg?
Intensive blood pressure control to a target of 120 mmHg provides significant cardiovascular and mortality benefits in older adults, including those who are frail.
May support intensive SBP targets in adults ≥75; leaves open confirmation in frail subgroups via prospective trials.
The Systolic Blood Pressure Intervention Trial (SPRINT; ClinicalTrials.gov, NCT01206062) was stopped early because of significantly lower risk of cardiovascular disease in participants randomized to a systolic blood pressure target of 120 mmHg (intensive) than in those randomized to 140 mmHg (standard). The cardiovascular outcome benefit was also identified in subjects aged 75 and older assigned to the intensive arm-34% lower than in the standard arm-in addition to 33% lower all-cause mortality at 3.14 years of follow-up. These beneficial outcomes held in older participants characterized as frail or with impaired gait speed. This article addresses several questions that need to be considered in applying the SPRINT results to the clinical care of older adults: Why are the SPRINT results discordant from those of epidemiological studies? Do the SPRINT findings generalize to the frail, older adults that I care for? Were there more adverse events in the intensive treatment group? What about cognitive and kidney outcomes? What are future considerations, and how low should we go?
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Supiano et al. (2016) studied this question.
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