SPRINT showed that in high-risk adults with hypertension but without diabetes or prior stroke, targeting SBP <120 mmHg reduced major cardiovascular events and all-cause mortality compared with SBP <140 mmHg, at the cost of more hypotension, syncope, electrolyte abnormalities, and AKI.
Study design
- Multicenter, randomized, open-label trial
- N = 9,361
- Adults with hypertension and increased cardiovascular risk
- Randomized to intensive vs standard SBP target
- Median follow-up 3.26 years
- Stopped early due to benefit in the intensive-treatment group
Population
Included
- Age ≥50 years
- SBP 130-180 mmHg
- Increased CV risk
- Clinical or subclinical CVD, CKD, Framingham 10-year risk ≥15%, or age ≥75
Excluded
- Diabetes mellitus
- 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 BP control
- Target SBP <120 mmHg
- Achieved mean SBP at 1 year: 121.4 mmHg
- Mean BP meds during follow-up: 2.8
Standard BP control
- Target SBP <140 mmHg
- Achieved mean SBP at 1 year: 136.2 mmHg
- Mean BP meds during follow-up: 1.8
Primary outcome
- Composite of MI, ACS without MI, stroke, acute decompensated HF, or CV death
- 1.65% per year with intensive treatment vs 2.19% per year with standard treatment
- HR 0.75, 95% CI 0.64-0.89
- P < 0.001
SBP <120 vs SBP <140
Primary composite endpoint, annualized event rate
2.4%
1.8%
1.2%
0.6%
0%
1.65%/yr vs 2.19%/yr | HR 0.75
Primary composite: MI, ACS without MI, stroke, acute decompensated HF, or CV death.
Secondary outcomes
| Outcome | Intensive | Standard | Effect |
|---|---|---|---|
| All-cause mortality | 1.03% per year | 1.40% per year | HR 0.73, 95% CI 0.60-0.90 |
| CV death | 0.25% per year | 0.43% per year | HR 0.57, 95% CI 0.38-0.85 |
| Heart failure | 0.41% per year | 0.67% per year | HR 0.62, 95% CI 0.45-0.84 |
Safety
- Overall serious adverse events were similar between groups
- Intensive treatment increased several treatment-related adverse events
| Adverse event | Intensive | Standard |
|---|---|---|
| Hypotension | 2.4% | 1.4% |
| Syncope | 2.3% | 1.7% |
| Electrolyte abnormality | 3.1% | 2.3% |
| AKI or acute renal failure | 4.1% | 2.5% |
| Injurious falls | 2.2% | 2.3% |
Practical point: SPRINT used automated office BP measurements, which may read lower than routine clinic BP. Do not blindly chase SBP <120 in frail, orthostatic, multimorbid, or symptomatic patients.
Interpretation
- For selected high-risk hypertensive adults, lower SBP targets reduce CV events and mortality.
- The strongest clinical signal was fewer HF events, CV deaths, and all-cause deaths.
- The tradeoff is more medication burden and more hypotension, syncope, electrolyte issues, and AKI.
- SPRINT does not directly apply to patients with diabetes, prior stroke, symptomatic HF, or nursing home-level frailty.
Citation: SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. New England Journal of Medicine. 2015;373:2103-2116.
NEJM