HelixTalk Episode #55 - How low can you go? Blood pressure limbo with SPRINT

Date posted: January 17, 2017, 6:00 am

In this episode, we discuss the SPRINT trial (intensive vs. standard blood pressure control) using a case vignette of Mr. Wilson, a 55 year old patient presenting to a clinic with a blood pressure of 139/89 mmHg.

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Key Concepts

1. SPRINT included older, non-diabetic patients at higher risk for cardiovascular disease and randomized patients to a systolic blood pressure goal of 120 mmHg vs. 140 mmHg.
2. Patients randomized to the lower blood pressure goal (intensive therapy) experienced a reduction in cardiovascular outcomes and even a benefit in all-cause mortality.
3. Intensive blood pressure lowering was associated with a greater risk of adverse effects, such as renal impairment, hypotension, and electrolyte abnormalities.
4. Because SPRINT checked blood pressure readings in a unique way, it isn’t clear whether a systolic goal of < 120 mmHg correlates to a “real life” blood pressure goal of the same value -- an issue with external validity.

References

SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015 Nov 26;373(22):2103-16. doi: 10.1056/NEJMoa1511939. Full-text PDF.