#2 Are You Treating Hypertension Adequately? Discussing the Implications of SPRINT.

March 1, 2016 | By Matthew Watto, MD

Are you treating Hypertension Adequately? Discussing the implications of SPRINT.

In this interview, Matt speaks with Dr. Paul Williams about the SPRINT Trial of Intensive blood pressure control and how it is likely to change clinical practice. Tony and Stuart were absent for the interview, but don’t freak out. We added their take home points on the SPRINT trial to the outro segment.

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Take home points:

1. Intensive systolic BP control decreased cardiovascular death, all-cause mortality, CHF
2. Beware about relaxing systolic BP goals (as recommended by JNC 8) in older patients with high CV risk*,**
3. In this trial, blood pressures were measured three times by an automatic cuff with patient seated, resting alone in an exam room (despite this fact, an average systolic BP goal of less than 120 mmHg was not reached in the trial)

*SPRINT included: Patients over 50 years old with any of the following: eGFR 20-60 ml/min, symptomatic or asymptomatic CV disease, age 75 years old or greater, Framingham 10 year Risk above 15%

**SPRINT excluded: institutionalized adults, patients with diabetes, active malignancy, proteinuria, or prior stroke

SPRINT

Trial Basics:

• Randomized, controlled trial of 9,361 patients to Intensive (systolic BP under 120) versus Standard (systolic BP under 140) BP control. The trial was stopped early after 3.3 years due to a significant decrease in the primary outcome for the Intensive treatment group.
• Primary Outcome: composite of MI, ACS, stroke, heart failure, cardiovascular death.
• Adverse events that were more common in the Intensive treatment group included: hypotension, acute kidney injury and syncope. There was NOT an increase in orthostasis or injurious falls in the Intensive treatment group.

Recommended References:

ACP Journal Club

The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015;373:2103-2116.

https://pubmed.ncbi.nlm.nih.gov/26551272/

ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:1575–1585. PMID: 20228401

http://www.ncbi.nlm.nih.gov/pubmed/20228401

HYVET Study group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887–98. PMID: 18378519 http://www.ncbi.nlm.nih.gov/pubmed/18378519

Recommended Items/Buys:

Omron Intellisense Blood Pressure Monitor

Tekita Pharmaceuticals Edarbi (Azilsartan)