Controlling Systolic Blood Pressure below 140 mm Hg in Most Hypertensive Patients matches Systolic Blood Pressure Intervention Trial Intensive Treatment: Practical Implications for Patient Care

Abstract

The Systolic Blood Pressure Intervention Trial (SPRINT) investigators concluded that most hypertensive patients would benefit from treating systolic blood pressure (SBP, mm Hg) to a target below 140 benchmark, as intensive treatment (SBP, 121.5) led to 25% fewer cardiovascular endpoints than standard treatment (SBP, 134.6) in high-risk patients. This conclusion reflects at least three assumptions addressed in this report. First, SBP with SPRINT standard was similar to or lower than SBP of treated adults in usual care. Second, SBP with SPRINT intensive treatment was lower than in adults with treated hypertension controlled to <140 with usual care. Third, SPRINTs rigorous blood pressure (BP) measurement methods translate to most care settings. Systolic blood pressure in a representative sample of US adults [National Health and Nutrition Examination Survey ≥18 years with treated hypertension fell from 137.1 in 1999-2002 to 130.1 in 2009-2012 as control to SBP <140 rose from 60 to 72%. Over the time, SBP in treated adults controlled to <140 fell from 123.0 to 120.9 as percentages with SBP <130 rose from 66.1 to 74.7%. The SPRINT BP measurement protocol led to SBP ~3 and ~7 below daytime ambulatory SBP for standard and intensive treatment respectively, whereas usual clinic SBP is ~5 above daytime ambulatory SBP. Thus, SBP 134.6 and 121.5 with SPRINT standard and intensive treatment are comparable to usual clinic SBP of 142.6 and 133.5 respectively. Systolic blood pressure intervention trial Intensive Treatment standard and intensive treatment fall short of SBP with usual care, especially when measurement methodologies are considered. Systolic blood pressure intervention trial supports the current SBP goal <140 based on usual clinic measurement methods.