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SPRINT post-hoc analysis: food for thought on defining the ideal blood pressure target



Barcelona, Spain – 28 Aug 2017:  Adding to the debate on optimal blood pressure control, new findings presented at ESC Congress today suggest there may be variations in the ideal target depending on baseline pressure and overall cardiovascular risk.

A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT), suggests that for some patients with systolic blood pressure (SBP) readings of 160 mmHg or more, lightening up on blood pressure control might be beneficial.

“The key message from our analysis is that a universal blood pressure target may not  be appropriate for all, and that for some with baseline SBP of 160 mmHg or more, the harms of aggressive treatment might outweigh the benefits,” said Tzung-Dau Wang, MD, PhD, from National Taiwan University Hospital.

“Although these results need further verification, it’s worth considering that a universal target of 120 mmHg might not be best for everyone,” he advised.

The SPRINT trial prompted widespread debate about blood pressure guidelines after showing significantly lower rates of fatal and nonfatal major cardiovascular events and death from any cause among intensively treated patients.

In all 9,361 subjects with an SBP of 130 mmHg or higher were randomised to either intensive treatment, which targeted an SBP of less than 120 mmHg, or standard treatment with a target of less than 140 mmHg.
 
But despite the study’s clear findings of better overall outcomes with intensive treatment, there were suggestions that aggressively lowering blood pressure could be associated with risks as well as benefits.

Now, the post-hoc analysis offers further insight.

Among the SPRINT participants, there were 480 who had a SBP of 160 mmHg or more.

The group’s median 10-¬year Framingham risk score was ≤31.3%. Within this group, after adjustment for age and sex, those who were randomised to the aggressive treatment arm had almost triple the risk of death from any cause compared to those treated less intensively (4.9% vs 1.7%, hazard ratio [HR] 3.12, [95% CI 1.00-9.69]; p=0.012), although the results barely reached statistical significance.

In contrast, there were no increased risks associated with intensive treatment among SPRINT subjects with lower baseline SBP.

Dr. Wang said these new results may help inform the debate that has ensued in the wake of the initial SPRINT results, and shed light on a sub-group of the study population who may more accurately represent “real world patients”.
“It seems there was an intricate interaction between each individual’s baseline blood pressure, their inherent cardiovascular risk, and their degree of blood pressure reduction - so we have to consider all three of these elements in managing hypertensive patients,” he concluded.

ENDS

Notes to editor

Sources of funding: None.

Disclosures: None.

References and notes
The study “Increased all-cause mortality with intensive blood-pressure control in patients with a baseline systolic blood pressure of >=160 mmHg and a Lower Framingham risk score: a cautionary note from SPRINT” will be presented during:
·    The press conference Clinical Trial Update 1 on Sunday 27August from 14:30 to 15:30.
·    The session Clinical Trial Update 1 on Monday 28 August from 14:00 to 15:30, in Dali - The Hub.


ESC Press Office
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The press conference timetable is available here.

To access all the scientific resources from the sessions during the congress, visit ESC Congress 365.  

About the European Society of Cardiology
The European Society of Cardiology brings together health care professionals from more than 140 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2017
ESC Congress is the world’s largest and most influential cardiovascular event contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2017 takes place 26 to 30 August at the Fira Gran Via in Barcelona, Spain. The scientific programme is here. More information is available from the ESC Press Office at press@escardio.org.

This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2017. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.