Systolic Blood Pressure Intervention Trial could
impact medical guidelines for treating hypertension, but questions remain
Newswise, November 10, 2015 — Patients whose blood pressure
target was lowered by medications to reach a systolic goal of 120 mmHg had
their risk for heart attack and heart failure reduced by 38 percent, and their
risk for death lowered by 27 percent.
Aggressive treatment appeared to be as effective for adults
age 75 and older as for adults age 50-74, according to results from the
Systolic Blood Pressure Intervention Trial (SPRINT) presented at the American
Heart Association meeting and published online in the <i>New
England Journal of Medicine (NEJM) on Nov. 9, 2015.
Intensive blood pressure management was also associated with
an increased risk for each of a group of adverse events categorized as life
threatening or requiring prolonged hospitalization or disability, including
hypotension, fainting, and kidney abnormalities.
Among these, there was
greatest increased risk, 64 percent, for acute kidney injury or acute renal
failure, although there was no evidence for permanent kidney damage. Future
studies will investigate effects of treatment on kidney disease in more detail.
“The positive results of this trial has taken everyone by
surprise, and the strong benefits of treatment seem to outweigh the risks,”
says Alfred Cheung, M.D., chief of nephrology & hypertension
at University of Utah Health Care, and co-author on the study. He led a network
of 17 out of the 102 participating clinical sites in the U.S. and Puerto Rico.
“Before deciding to treat blood pressure aggressively, it may be smarter to
wait until additional questions are answered.”
He notes that results are still pending on how intensive
treatment might impact dementia, cognition, and kidney disease.
Additionally,
nothing is known about long-term effects of sustained treatment, nor cost
effectiveness. On average, SPRINT trial participants were followed for just
over three years.
In Sept, 2015, the National Institutes of Health announced
that the SPRINT trial was stopped one year early due to the
marked benefits of lowering systolic blood pressure to 120 mmHg, well below the
current guidelines of 140, or 150 for those over age 60.
Now, the details of
the study are published in NEJM. The results may have implications for the 79
million Americans and 1 billion adults worldwide with hypertension, or high
blood pressure, the leading cause of heart disease and stroke.
Adults age 75 and older could potentially benefit the most
from interventions based on positive SPRINT results because this age group
carries the burden of hypertension: over 75 percent have the condition.
At the
same time, they would be predicted to be most at risk for any potential side
effects that are still under investigation, says Mark Supiano, M.D., chief of
geriatrics at University of Utah Health Care and director of the VA Salt Lake
City Geriatric Research, Education, and Clinical Center.
“If there were a single drug with this kind of beneficial
outcome, it would be a billion-dollar drug,” says Supiano. “But we can’t just
treat the heart, we need to treat the whole person. We will need to exercise
caution when implementing this information.”
SPRINT randomly assigned over 9,300 participants one of two
blood pressure targets: less than 120 mmHg or less than 140. Participants were
age 50 or older, at increased risk for cardiovascular disease, had an systolic
blood pressure of at least 130 mmHg, and did not have diabetes, history of
stroke, or kidney disease.
Blood pressure was adjusted with antihypertensive
medication over the course of the first year, and participants were monitored
for an average of three additional years.
The results from SPRINT differ from previous trials
demonstrating that a blood pressure target of 120 mmHg did not significantly
reduce risk for death.
Cheung says the difference in outcomes may stem from
SPRINT’s large sample size and its unique eligibility requirements, which
included an older population and individuals with high risk for cardiovascular
disease, and excluded patients with diabetes.
“We saw great health improvements in just three years, but it
could be that outcomes will improve even more over the course of 10 years, or
30,” says Cheung.
It remains to be determined whether SPRINT results will
influence official medical guidelines for treating hypertension.
The research was supported by the National Heart, Lung, and
Blood Institute, National Institute of Diabetes and Digestive and Kidney
Diseases, National Institute on Aging, National Institute of Neurological
Disorders and Stroke, and the Department of Veterans Affairs
“Principle Results of the Systolic Blood Pressure Intervention
Trial (SPRINT)” will be published online in NEJM on Nov. 9
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