SPRINT

Intensive vs standard systolic blood pressure control
In high-risk adults without diabetes or prior stroke, targeting SBP <120 mmHg reduced major cardiovascular events and mortality compared with <140 mmHg, with more hypotension, syncope, electrolyte abnormalities and AKI

Study design

  • Multicenter randomized open-label trial
  • N = 9,361
  • Increased cardiovascular risk + hypertension
  • SBP target <120 vs <140 mmHg
  • Median follow-up 3.26 years
  • Stopped early for cardiovascular benefit

Population

Included
  • Age ≥50 years
  • SBP 130–180 mmHg
  • Increased CV risk
  • Clinical/subclinical CVD, CKD, ≥15% Framingham risk or age ≥75
Key exclusions
  • Diabetes
  • Prior stroke
  • Symptomatic HF or LVEF <35%
  • Standing SBP <110 mmHg
  • Nursing home residence
Mean age 68 28% age ≥75 36% women 28% CKD No diabetes No prior stroke

Interventions

Intensive treatment
  • Target SBP <120 mmHg
  • Mean SBP at 1 year: 121.4 mmHg
  • Mean antihypertensives: 2.8
Standard treatment
  • Target SBP <140 mmHg
  • Mean SBP at 1 year: 136.2 mmHg
  • Mean antihypertensives: 1.8

Primary outcome

MI, ACS, stroke, HF or cardiovascular death
1.65%/yr intensive vs 2.19%/yr standard
HR 0.75, 95% CI 0.64–0.89, P < 0.001
NNT: 61 over 3.26 years to prevent one primary cardiovascular outcome

SBP <120 vs <140 mmHg

Annualized primary cardiovascular event rate

2.4% 1.8% 1.2% 0.6% 0%
1.65%
SBP <120
Intensive
2.19%
SBP <140
Standard
1.65%/yr vs 2.19%/yr  |  HR 0.75  |  95% CI 0.64–0.89

Intensive BP control reduced the primary cardiovascular outcome by 25% relative

Secondary outcomes

All-cause mortality

1.03%/yr vs 1.40%/yr
HR 0.73, P = 0.003

Cardiovascular death

0.25%/yr vs 0.43%/yr
HR 0.57, P = 0.005

Heart failure

0.41%/yr vs 0.67%/yr
HR 0.62

Mortality NNT

90 over 3.26 years
To prevent one death

Safety

Hypotension

2.4% vs 1.4%
Increased with intensive therapy

Syncope

2.3% vs 1.7%
Increased with intensive therapy

Electrolyte abnormality

3.1% vs 2.3%
Increased with intensive therapy

AKI / acute renal failure

4.1% vs 2.5%
Increased with intensive therapy

Injurious falls

2.2% vs 2.3%
No increase

Intensive treatment improved cardiovascular outcomes but increased several treatment-related adverse events

Clinical interpretation

  • Lower SBP targets reduce cardiovascular events and mortality in selected high-risk adults
  • Benefits were particularly notable for HF, cardiovascular death and all-cause mortality
  • Intensive control requires more medication and closer monitoring
  • Watch for orthostasis, hypotension, electrolyte changes and AKI
  • SPRINT does not directly apply to diabetes or prior stroke
Think: High CV risk + tolerates therapy → consider SBP target <120 mmHg using standardized BP measurement

Limitations

  • Excluded diabetes and prior stroke
  • Excluded symptomatic HF and LVEF <35%
  • Trial stopped early for benefit
  • Intensive BP management required frequent structured follow-up
  • BP measurement protocol differed from many routine clinic workflows
A target of <120 mmHg should not be applied blindly to every patient with hypertension. Patient selection, BP measurement technique, symptoms, orthostasis, renal function and treatment tolerance matter
SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373:2103–2116. doi:10.1056/NEJMoa1511939. NEJM