1932

Abstract

The Systolic Blood Pressure Intervention Trial is the first large prospective randomized controlled trial to demonstrate the benefit of an intensive systolic blood pressure (SBP) treatment target (<120 mm Hg) compared to a standard target (<140 mm Hg) in reducing cardiovascular morbidity and mortality and all-cause mortality in high-risk hypertensive patients. The impact of SPRINT on hypertension treatment has been large, but major questions remain about the feasibility of achieving the SPRINT intensive SBP target in routine practice, the generalizability of the SPRINT findings to hypertensive populations that were excluded from the trial, and the cost effectiveness of adopting the SPRINT intensive treatment goal. In this review, we discuss the generalizability of SPRINT data to the general population of adults with hypertension and with various comorbidities, the cost effectiveness of intensive SBP-lowering therapy, and the implications of SPRINT for future hypertension guideline development and clinical practice.

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2018-01-29
2024-07-23
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Literature Cited

  1. Forouzanfar MH, Afshin A, Alexander LT. 1.  et al. GBD 2015 Risk Factors Collaborators 2016. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388:1659–724 [Google Scholar]
  2. Ezzati M, Lopez AD, Rodgers A. 2.  et al. 2002. Selected major risk factors and global and regional burden of disease. Lancet 360:1347–60 [Google Scholar]
  3. Danaei G, Finucane MM, Lin JK. 3.  et al. Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Blood Pressure) 2011. National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5.4 million participants. Lancet 377:568–77 [Google Scholar]
  4. Lewington S, Clarke R, Qizilbash N. 4.  et al. 2002. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360:1903–13 [Google Scholar]
  5. Ettehad D, Emdin CA, Kiran A. 5.  et al. 2016. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 387:957–67 [Google Scholar]
  6. Xie X, Atkins E, Lv J. 6.  et al. 2016. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet 387:435–43 [Google Scholar]
  7. Thomopoulos C, Parati G, Zanchetti A. 7.  2016. Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more versus less intensive blood pressure lowering and different achieved blood pressure levels—updated overview and meta-analyses of randomized trials. J. Hypertens. 34:613–22 [Google Scholar]
  8. Brunström M, Carlberg B. 8.  2016. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ 352:i717 [Google Scholar]
  9. Sundström J, Arima H, Woodward M. 9.  et al. 2014. Blood pressure–lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet 384:591–98 [Google Scholar]
  10. Wright JT, Williamson JD, Whelton PK. 10.  et al. 2015. A randomized trial of intensive versus standard blood-pressure control. N. Engl. J. Med. 373:2103–16 [Google Scholar]
  11. Ambrosius WT, Sink KM, Foy CG. 11.  et al. 2014. The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clin. Trials 11:532–46 [Google Scholar]
  12. 12. Kidney Disease: Improving Global Outcomes (KDIGO) Chronic Kidney Disease Work Group. 2013. KDIGO 2012 Clinical Practice Guideline for the evaluation and management of chronic kidney disease. Kidney Int. Suppl. 3:1–150 [Google Scholar]
  13. Rocco MV, Sink KM, Lovato LC. 13.  et al. 2017. Effects of intensive blood pressure treatment on acute kidney injury events in the SPRINT study. J. Am. Soc. Nephrol. In press. http://dx.doi.org/10.1053/j.ajkd.2017.08.021 [Crossref] [Google Scholar]
  14. Bress AP, Tanner RM, Hess R. 14.  et al. 2016. Generalizability of SPRINT results to the U.S. adult population. J. Am. Coll. Cardiol. 67:463–72 [Google Scholar]
  15. Bress AP, Kramer H, Khatib R. 15.  et al. 2017. Potential deaths averted and serious adverse events incurred from adoption of the SPRINT intensive blood pressure regimen in the U.S.: projections from NHANES. Circulation 135:1617–28 [Google Scholar]
  16. 16. National Center for Health Statistics. 2016. Health, United States, 2015: With special feature on racial and ethnic health disparities Natl. Cent. Health Stat., Cent. Dis. Control Prev., US. Dep. Health Hum. Serv., Hyattsville, MD. https://www.cdc.gov/nchs/data/hus/hus15.pdf [Google Scholar]
  17. Bhatt H, Ghazi L, Calhoun D, Oparil S. 17.  2016. BP targets in hypertension: What should we do now that SPRINT is out?. Curr. Cardiol. Rep. 18:98 [Google Scholar]
  18. Perkovic V, Rodgers A. 18.  2015. Redefining blood pressure targets—SPRINT starts the marathon. N. Engl. J. Med. 373:2175–78 [Google Scholar]
  19. Oparil S, Lewis CE. 19.  2016. Should patients with cardiovascular risk factors receive intensive treatment of hypertension to <120/80 mmHg target? A protagonist view from the SPRINT trial (Systolic Blood Pressure Intervention Trial). Circulation 134:1308–10 [Google Scholar]
  20. Oparil S. 20.  2016. SPRINT trial results. Eur. Heart J. CardioPulse 37:924–36 [Google Scholar]
  21. Cushman WC, Whelton PK, Fine LJ. 21.  et al. 2016. SPRINT trial results: latest news in hypertension management. Hypertension 67:263–65 [Google Scholar]
  22. Chobanian AV. 22.  2015. Time to reassess blood pressure goals. N. Engl. J. Med. 373:2093–95 [Google Scholar]
  23. Rodgers A, Salam A. 23.  2016. Accumulating evidence of benefits from intensive blood pressure lowering: Are we there yet?. Hypertension 68:546–48 [Google Scholar]
  24. Verdecchia P, Angeli F, Gentile G, Reboldi G. 24.  2016. More versus less intensive blood pressure–lowering strategy: cumulative evidence and trial sequential analysis. Hypertension 68:642–53 [Google Scholar]
  25. Patel KK, Arnold SV, Chan PS. 25.  et al. 2017. Personalizing the intensity of blood pressure control: modeling the heterogeneity of risks and benefits from SPRINT (Systolic Blood Pressure Intervention Trial). Circ. Cardiovasc. Qual. Outcomes 10:4 pii:e003624 [Google Scholar]
  26. Whelton PK, Chen J, Krousel-Wood M. 26.  2017. Lessons learned from Systolic Blood Pressure Intervention Trial. Curr. Opin. Cardiol. 32:407–12 [Google Scholar]
  27. Staessen JA, Li Y, Hara A. 27.  et al. 2017. Blood pressure measurement anno 2016.. Am. J. Hypertens. 30:453–63 [Google Scholar]
  28. Wenger NK, Ferdinand KC, Bairey Merz CN. 28.  et al. 2016. Women, hypertension, and the Systolic Blood Pressure Intervention Trial. Am. J. Med. 129:1030–36 [Google Scholar]
  29. Townsend RR, Epstein M. 29.  2016. Resistant hypertension: insights on evaluation and management in the post-SPRINT era. Hypertension 68:1073–80 [Google Scholar]
  30. Kovesdy CP. 30.  2017. Hypertension in chronic kidney disease after the Systolic Blood Pressure Intervention Trial: targets, treatment and current uncertainties. Nephrol. Dial. Transplant 32:ii219–ii23 [Google Scholar]
  31. Tyson CC, Coffman TM. 31.  2017. In the wake of Systolic Blood Pressure Intervention Trial: new targets for improving hypertension management in chronic kidney disease?. Nephron 135:287–90 [Google Scholar]
  32. Ruiz-Hurtado G, Banegas JR, Sarafidis PA. 32.  et al. 2017. Has the SPRINT trial introduced a new blood-pressure goal in hypertension?. Nat. Rev. Cardiol. 14:560–66 [Google Scholar]
  33. Sica DA, Phillips RA, White WB. 33.  et al. 2016. “Translational” medicine: transforming SPRINT findings into clinical practice. J. Am. Soc. Hypertens. 10:382–86 [Google Scholar]
  34. Kjeldsen SE, Lund-Johansen P, Nilsson PM, Mancia G. 34.  2016. Unattended blood pressure measurements in the Systolic Blood Pressure Intervention Trial: implications for entry and achieved blood pressure values compared with other trials. Hypertension 67:808–12 [Google Scholar]
  35. Kjeldsen SE, Oparil S, Narkiewicz K, Hedner T. 35.  2016. The J-curve phenomenon revisited again: SPRINT outcomes favor target systolic blood pressure below 120mmHg. Blood Press 25:1–3 [Google Scholar]
  36. Williamson JD, Supiano MA, Applegate WB. 36.  et al. 2016. Intensive versus standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial.JAMA. 3152673–82
  37. Supiano MA, Williamson JD. 37.  2017. Applying the Systolic Blood Pressure Intervention Trial results to older adults. J. Am. Geriatr. Soc. 65:16–21 [Google Scholar]
  38. Odden MC, Peralta CA, Berlowitz DR. 38.  et al. 2017. Effect of intensive blood pressure control on gait speed and mobility limitation in adults 75 years or older: a randomized clinical trial. JAMA Intern. Med. 177:500–7 [Google Scholar]
  39. Studenski S, Perera S, Patel K. 39.  et al. 2011. Gait speed and survival in older adults. JAMA 305:50–58 [Google Scholar]
  40. Perera S, Patel KV, Rosano C. 40.  et al. 2016. Gait speed predicts incident disability: a pooled analysis. J. Gerontol. A Biol. Sci. Med. Sci. 71:63–71 [Google Scholar]
  41. Materson BJ, Garcia-Estrada M, Preston RA. 41.  2016. Hypertension in the frail elderly. J. Am. Soc. Hypertens. 10:536–41 [Google Scholar]
  42. Chobanian AV. 42.  2016. SPRINT results in older patients: how low to go?. JAMA 315:2669–70 [Google Scholar]
  43. Covic A, Apetrii M, Goldsmith D, Kanbay M. 43.  2016. SPRINT: the study nephrologists might take with a grain of salt. J. Clin. Hypertens. 18:1185–88 [Google Scholar]
  44. Chertow GM, Beddhu S, Lewis JB. 44.  et al. 2016. Managing hypertension in patients with CKD: a marathon, not a sprint. J. Am. Soc. Nephrol. 27:40–43 [Google Scholar]
  45. Gosmanova EO, Kovesdy CP. 45.  2016. Blood pressure targets in CKD: lessons learned from SPRINT and previous observational studies. Curr. Cardiol. Rep. 18:88 [Google Scholar]
  46. Taler SJ. 46.  2016. How does SPRINT (Systolic Blood Pressure Intervention Trial) direct hypertension treatment targets for CKD?. Am. J. Kidney Dis. 68:15–18 [Google Scholar]
  47. Cheung AK, Rahman M, Reboussin DM. 47.  et al. SPRINT Research Group 2017. Effects of intensive BP control in CKD. J. Am. Soc. Nephrol. 28:92812–23 [Google Scholar]
  48. Bakris GL, Weir MR. 48.  2000. Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine: Is this a cause for concern?. Arch. Intern. Med. 160:685–93 [Google Scholar]
  49. Apperloo AJ, de Zeeuw D, de Jong PE. 49.  1997. A short-term antihypertensive treatment-induced fall in glomerular filtration rate predicts long-term stability of renal function. Kidney Int 51:793–97 [Google Scholar]
  50. Weiner DE, Bartolomei K, Scott T. 50.  et al. 2009. Albuminuria, cognitive functioning, and white matter hyperintensities in homebound elders. Am. J. Kidney Dis. 53:438–47 [Google Scholar]
  51. Kurella Tamura M, Muntner P, Wadley V. 51.  et al. 2011. Albuminuria, kidney function, and the incidence of cognitive impairment among adults in the United States. Am. J. Kidney Dis. 58:756–63 [Google Scholar]
  52. Yaffe K, Kurella-Tamura M, Ackerson L. 52.  et al. 2014. Higher levels of cystatin C are associated with worse cognitive function in older adults with chronic kidney disease: the chronic renal insufficiency cohort cognitive study. J. Am. Geriatr. Soc. 62:1623–29 [Google Scholar]
  53. Martens RJ, Kooman JP, Stehouwer CD. 53.  et al. 2017. Estimated GFR, albuminuria, and cognitive performance: the Maastricht Study. Am. J. Kidney Dis. 69:179–91 [Google Scholar]
  54. Weiner DE, Gaussoin SA, Nord J. 54.  et al. SPRINT Research Group 2017. Cognitive function and kidney disease: baseline data from the SPRINT trial. Am. J. Kidney Dis. 70:357–67 [Google Scholar]
  55. Seliger SL, Weiner DE. 55.  2013. Cognitive impairment in dialysis patients: Focus on the blood vessels?. Am. J. Kidney Dis. 61:187–90 [Google Scholar]
  56. Owan TE, Hodge DO, Herges RM. 56.  et al. 2006. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N. Engl. J. Med. 355:251–59 [Google Scholar]
  57. Levy D, Larson MG, Vasan RS. 57.  et al. 1996. The progression from hypertension to congestive heart failure. JAMA 275:1557–62 [Google Scholar]
  58. Upadhya B, Rocco M, Lewis CE. 58.  et al. 2017. Effect of intensive blood pressure treatment on heart failure events in the Systolic Blood Pressure Reduction Intervention Trial. Circ. Heart Fail. 10:pii: e003613 [Google Scholar]
  59. Rosamond WD, Chang PP, Baggett C. 59.  et al. 2012. Classification of heart failure in the Atherosclerosis Risk In Communities (ARIC) study: a comparison of diagnostic criteria. Circ. Heart Fail. 5:152–59 [Google Scholar]
  60. Yancy CW, Jessup M, Bozkurt B. 60.  et al. 2017. ACC/AHA/HFSA focused update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation 136:e137–61 [Google Scholar]
  61. Gerstein HC, Miller ME, Byington RP. 61.  et al. 2008. Effects of intensive glucose lowering in type 2 diabetes. N. Engl. J. Med. 358:2545–59 [Google Scholar]
  62. Cushman WC, Evans GW, Byington RP. 62.  et al. 2010. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N. Engl. J. Med. 362:1575–85 [Google Scholar]
  63. Sarafidis PA, Lazaridis AA, Ruiz-Hurtado G, Ruilope LM. 63.  2017. Blood pressure reduction in diabetes: lessons from ACCORD, SPRINT and EMPA-REG OUTCOME. Nat. Rev. Endocrinol. 13:365–74 [Google Scholar]
  64. Margolis KL, O'Connor PJ, Morgan TM. 64.  et al. 2014. Outcomes of combined cardiovascular risk factor management strategies in type 2 diabetes: the ACCORD randomized trial. Diabetes Care 37:1721–28 [Google Scholar]
  65. Cushman WC, Evans GW, Cutler JA. 65. ACCORD/ACCORDION Study Group. 2016. Long-term cardiovascular effects of 4.9 years of intensive blood pressure control in type 2 diabetes mellitus: the Action to Control Cardiovascular Risk in Diabetes Follow-On Blood Pressure Study. Circulation 132:2281 [Google Scholar]
  66. Brunström M, Eliasson M, Nilsson PM, Carlberg B. 66.  2017. Blood pressure treatment levels and choice of antihypertensive agent in people with diabetes mellitus: an overview of systematic reviews. J. Hypertens. 35:453–62 [Google Scholar]
  67. Reboldi G, Gentile G, Angeli F. 67.  et al. 2011. Effects of intensive blood pressure reduction on myocardial infarction and stroke in diabetes: a meta-analysis in 73,913 patients. J. Hypertens. 29:1253–69 [Google Scholar]
  68. Bangalore S, Kumar S, Lobach I, Messerli FH. 68.  2011. Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from traditional and Bayesian random-effects meta-analyses of randomized trials. Circulation 123:2799–810 [Google Scholar]
  69. Arguedas JA, Leiva V, Wright JM. 69.  2013. Blood pressure targets for hypertension in people with diabetes mellitus. Cochrane Database Syst. Rev. 10:CD008277 [Google Scholar]
  70. Turnbull F, Neal B, Algert C. 70.  et al. 2005. Effects of different blood pressure–lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized 18 trials. Arch. Intern. Med. 165:1410–19 [Google Scholar]
  71. Drawz PE, Pajewski NM, Bates JT. 71.  et al. 2017. Effect of intensive versus standard clinic-based hypertension management on ambulatory blood pressure: results from the SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory blood pressure study. Hypertension 69:42–50 [Google Scholar]
  72. Culleton BF, McKay DW, Campbell NR. 72.  2006. Performance of the automated BpTRU measurement device in the assessment of white-coat hypertension and white-coat effect. Blood Press Monit 11:37–42 [Google Scholar]
  73. Lamarre-Cliché M, Cheong NN, Larochelle P. 73.  2011. Comparative assessment of four blood pressure measurement methods in hypertensives. Can. J. Cardiol. 27:455–60 [Google Scholar]
  74. Myers MG, Godwin M, Dawes M. 74.  et al. 2010. Measurement of blood pressure in the office: recognizing the problem and proposing the solution. Hypertension 55:195–200 [Google Scholar]
  75. Myers MG, Godwin M, Dawes M. 75.  et al. 2011. Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial. BMJ 342:d286 [Google Scholar]
  76. Agarwal R. 76.  2017. Implications of blood pressure measurement technique for implementation of Systolic Blood Pressure Intervention Trial (SPRINT). JAMA 6:e004536 [Google Scholar]
  77. Filipovský J, Seidlerová J, Kratochvíl Z. 77.  et al. 2016. Automated compared to manual office blood pressure and to home blood pressure in hypertensive patients. Blood Press 25:228–34 [Google Scholar]
  78. Drawz PE, Abdalla M, Rahman M. 78.  2012. Blood pressure measurement: clinic, home, ambulatory, and beyond. Am. J. Kidney Dis. 60:449–62 [Google Scholar]
  79. Myers MG, Kaczorowski J, Dolovich L. 79.  et al. 2016. Cardiovascular risk in hypertension in relation to achieved blood pressure using automated office blood pressure measurement. Hypertension 68:866–72 [Google Scholar]
  80. 80. US Prev. Serv. Task Force. 2015. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann. Int. Med. 163:778–86 [Google Scholar]
  81. Piper MA, Evans CV, Burda BU. 81.  et al. 2015. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force. Ann. Intern. Med. 162:192–204 [Google Scholar]
  82. 82. Natl. Inst. Health Clin. Excell. 2011. Hypertension in adults: diagnosis and management. Clinical guideline CG127, updated Nov. 2016; accessed May 3, 2017. http://www.nice.org.uk/guidance/cg127
  83. Bhatt DL, Kandzari DE, O'Neill WW. 83.  et al. SYMPLICITY HTN-3 Investigators 2014. A controlled trial of renal denervation for resistant hypertension. N. Engl. J. Med. 370:1393–1401 [Google Scholar]
  84. Bress AP, Bellows BK, King J. 84.  et al. 2017. Cost-effectiveness of intensive versus standard blood pressure control. N. Engl. J. Med. 377:745–55 [Google Scholar]
  85. Anderson JL, Heidenreich PA, Barnett PG. 85.  et al. 2014. ACC/AHA statement on cost/value methodology in clinical practice guidelines and performance measures: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 63:2304–22 [Google Scholar]
  86. Neumann PJ, Cohen JT, Weinstein MC. 86.  2014. Updating cost-effectiveness: the curious resilience of the $50,000-per-QALY threshold. N. Engl. J. Med. 371:796–97 [Google Scholar]
  87. Moise N, Huang C, Rodgers A. 87.  et al. 2016. Comparative cost-effectiveness of conservative or intensive blood pressure treatment guidelines in adults aged 35–74 years: the cardiovascular disease policy model. Hypertension 68:88–96 [Google Scholar]
  88. Richman IB, Fairley M, Jørgensen ME. 88.  et al. 2016. Cost-effectiveness of intensive blood pressure management. JAMA Cardiol 1:872–79 [Google Scholar]
  89. Berlowitz DM, Foy CG, Kazis LE. 89.  et al. 2017. Effect of intensive blood-pressure treatment on patient-reported outcomes. N. Engl. J. Med. 377:733–44 [Google Scholar]
  90. Leung AA, Nerenberg K, Daskalopoulou SS. 90.  et al. 2016. Hypertension Canada's 2016 Canadian Hypertension Education Program guidelines for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can. J. Cardiol. 32:569–88 [Google Scholar]
  91. 91. Natl. Heart Found. Aust. 2016. Guideline for the diagnosis and management of hypertension in adults—2016 Melbourne: Natl. Heart Found. Aust https://www.heartfoundation.org.au/images/uploads/publications/PRO-167_Hypertension-guideline-2016_WEB.pdf [Google Scholar]
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