SPS3 Evidence Supports Intensive Blood Pressure Control

I nterest in identifying the most appropriate targets for sys- tolic blood pressure (SBP) lowering to reduce cardiovascular events in persons with hypertension has been piqued by the widely publicized results of the Systolic Blood Pressure Intervention Trial (SPRINT).1,2 SPRINT found overwhelming benefit (25% reduction in the primary composite outcome of myocardial infarction [MI], acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure, or death from cardiovascular causes) and 27% reduction in all-cause mortality among participants randomly assigned to a SBP target of <120 mm Hg (intensive treatment) in comparison with <140 mm Hg (standard treatment).In contrast, serious adverse events, including acute kidney injury or acute renal failure that contributed to hospitalizations or emergency department visits were significantly more common in the intensive treatment group (4.4% versus 2.6%, hazard ratio, 1.71; P<0.001).Among those who did not have chronic kidney disease (CKD) at baseline, incident CKD, defined as a decrease in estimated glomerular filtration rate (eGFR) of ≥30% to a level of <60 mL•min -1 •1.73 m -2 occurred more frequently in the intensive treatment group (1.21%/y versus 0.35%/y).Among those with CKD at baseline, few reached the primary renal end point of decrease in eGFR ≥50% or endstage renal disease (ESRD).Incident albuminuria, another measure of kidney damage, did not differ between treatment groups.The investigators concluded that available data provide no evidence of substantial permanent kidney injury associated with the lower SBP goal in SPRINT, but that the possibility of such adverse outcomes cannot be excluded and that longer follow-up data that include more clinical outcomes and analyses of rates of fall in eGFR are needed to address this important issue.