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Evevident
Original paper
2015NEJMCardiology

SPRINT

A Randomized Trial of Intensive versus Standard Blood-Pressure Control

RCTHypertension

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Overview

In high-risk non-diabetic adults, targeting SBP <120 mm Hg reduced major CV events and mortality versus <140 mm Hg, at the cost of more adverse events.

Clinical takeaway

SPRINT drove lower BP targets for selected high-risk patients, but its automated BP measurement protocol and exclusion of diabetes/stroke are essential when applying it.

Key result

Intensive control reduced the primary composite outcome (HR 0.75; 95% CI 0.64-0.89).

Practice impact

Supports intensive BP targets in carefully selected high-risk patients when adverse-event risk is acceptable.

Evidence

Study design

Randomized, open-label, controlled trial.

Enrollment

9,361

Follow-up

Median 3.26 years; stopped early for benefit.

Geography

United States, Puerto Rico

Clinical question

Does intensive SBP control improve outcomes compared with standard SBP control in high-risk adults without diabetes?

Population

  • Adults >=50 years with SBP >=130 mm Hg and elevated cardiovascular risk, excluding diabetes and prior stroke.

Intervention

SBP target <120 mm Hg.

Comparator

SBP target <140 mm Hg.

Primary outcome

Composite of MI, ACS, stroke, acute decompensated HF, or CV death.

Targeting SBP <120 mm Hg reduced major cardiovascular events and all-cause mortality compared with a <140 mm Hg target.

Hazard ratio / 0.75 / CI 95% CI 0.64-0.89 / p=<0.001

Key results

  • Primary composite outcome: 1.65%/yr with intensive vs 2.19%/yr with standard treatment; HR 0.75; 95% CI 0.64-0.89; p<0.001.
  • All-cause mortality was lower with intensive treatment: HR 0.73; 95% CI 0.60-0.90; p=0.003.
  • Benefit was driven by reductions in heart failure and cardiovascular death.
  • Serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury were more frequent with intensive treatment.

Harms

  • Hypotension, syncope, and electrolyte abnormalities were more common with intensive treatment.
  • Acute kidney injury or failure was more common with intensive treatment.
  • Injurious falls were not increased by intensive treatment.

Clinical Use

When to cite

  • When justifying an intensive BP target in a high-risk patient without diabetes, while noting SPRINT used protocolized automated measurement and excluded diabetes and prior stroke.

Practice impact

  • Supports intensive BP targets in carefully selected high-risk patients when adverse-event risk is acceptable.

Applicability

  • Most applicable to adults >=50 years with elevated systolic blood pressure and high cardiovascular risk, without diabetes or prior stroke.

Limitations

  • Excluded diabetes and prior stroke.
  • Used automated, often unattended office BP measurement that may read lower than routine clinic BP, so the <120 target does not translate directly to a standard cuff reading.
  • More treatment-related adverse events including AKI and hypotension.

Common misinterpretations

  • Do not equate the SPRINT <120 target with a routine clinic reading; protocolized measurement typically yields lower values.
  • SPRINT excluded patients with diabetes and prior stroke, so its target should not be applied uncritically to those groups (ACCORD-BP did not show the same benefit in diabetes).

Related evidence

ACCORD - Context

Citation

SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103-2116. doi:10.1056/NEJMoa1511939

Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause.