The SPRINT trial: A major advance in treating high blood pressure

There are few advances in medicine that truly warrant an immediate change in practice, but the SPRINT trial appears to be one such study. In a recent press release, the SPRINT researchers announced that their study results showed aiming for a systolic blood pressure (the top number) of 120 mm Hg was superior to a target of 140 mm Hg. This one change reduced the risk of death by almost 25% and reduced the rate of overall cardiovascular problems, including heart attacks, strokes, and heart failure, by almost a third — welcome news to every doctor and patient.

The SPRINT trial was a randomized clinical trial that followed over 9,000 Americans for several years. All participants in the trial were ages 50 and older, had high blood pressure, and also either were at increased risk for heart disease or had kidney disease. Half the participants were given a blood pressure target of 120 mm Hg and the other half were given a target of 140 mm Hg. On average, the 120 mm Hg group needed 3 blood pressure medications to achieve this goal, and the 140 mm Hg group needed 2.

This study was sponsored primarily by the National Heart, Lung, and Blood Institute of the National Institutes of Health. This trial is a wonderful example of the kind of long-term, large-scale clinical trials that are necessary to advance patient care meaningfully. The study results also illustrate the importance of randomized clinical trials — that is, studies in which patients are randomly assigned to one of two treatment arms. Lastly, credit must be given to the participants who consented to be enrolled in the study. They have generously and selflessly contributed to advancing medical science and improving the care of patients worldwide. Ultimately, they also helped improve their own care.

While the results are very exciting, it will be important to see the details in the full text of the study, which has yet to be published. Sometimes a published paper provides more subtle interpretations of the findings than an initial press release. Those usual caveats notwithstanding, these results appear to be an important discovery with instant applicability.

It usually takes years before the effects of high blood pressure (at least, in the range being studied in this trial) cause serious cardiovascular problems. So, for people with reasonably well-controlled blood pressure, there is no need to rush to see your doctor right away.

However, even if your blood pressure is considered well-controlled under current standards, it would be worthwhile to discuss with your primary care physician whether a lower target blood pressure would be in order. Of course, you and your physician would need to balance the benefits noted in the SPRINT trial against the potential risks of taking additional blood pressure medications and their possible side effects. The risk of side effects might be higher in certain groups of patients, such as older people taking several different types of drugs. Still, the availability of multiple generic blood pressure medicines should allow these results to be applied in the vast majority of people with high blood pressure.