SPRINT — Intensive vs Standard Blood-Pressure Control

Design

SPRINT randomised 9,361 adults ≥50 with systolic BP 130–180, increased cardiovascular risk, and no diabetes or prior stroke to intensive systolic target <120 vs standard <140 mmHg. Stopped early for efficacy at median 3.3 years.

Findings

• Primary composite (MI, ACS, stroke, heart failure, CV death): 25% relative reduction.
• All-cause mortality: 27% relative reduction.
• Adverse events: more syncope, electrolyte abnormalities, acute kidney injury in intensive arm.
• Cognitive sub-study (SPRINT-MIND): reduced incidence of mild cognitive impairment.

Implications

Lowered guideline targets for many high-risk adults to systolic <130 (US 2017 hypertension guidelines moved the threshold; European guidelines followed with selective recommendations).

Caveats

• Office BP in SPRINT was measured by unattended automated readings, which give ~5–10 mmHg lower than usual office readings — the “intensive 120” equates to roughly 125–130 by conventional method.
• The trial excluded diabetics and prior stroke; benefit/risk in those groups required separate trials (ACCORD-BP showed less clear benefit; RESPECT in stroke survivors mixed).
• Older, frailer adults need individualised decisions; harms become more important.

Related entries

Blood pressure, Cardiovascular disease, Cognitive decline.