Implications of Blood Pressure Measurement Technique for Implementation of Systolic Blood Pressure Intervention Trial (SPRINT)

Abstract

BackgroundCardiovascular morbidity and mortality was reduced by 25% when blood pressure (BP) was targeted to 120 mm Hg systolic compared with 140 mm Hg systolic in Systolic Blood Pressure Intervention Trial (SPRINT); however, BP was measured using a research technique. SPRINT specified 5 minutes of seated rest in a quiet room followed by 3 oscillometric measurements without an observer in the room. The relationship of this research‐grade methodology to routine BP measurements is not known.Methods and ResultsAmong 275 people with chronic kidney disease who had BP <140/90 mm Hg when they came to the clinic, we measured BP as in SPRINT and recorded BP on the same day without specification of seated rest. Compared with routine measurement, the research‐grade systolic BP was 12.7 mm Hg lower with wide limits of agreement (−46.1 to 20.7 mm Hg). Research grade systolic BP was 7.9 mm Hg lower than daytime ambulatory systolic BP and had wide agreement limits (−33.2 to 17.4 mm Hg). Whereas the routine, research‐grade, and daytime ambulatory systolic BP were all related to echocardiographic left ventricular hypertrophy, the strength of the relationship between research‐grade and daytime ambulatory systolic BP to left ventricular hypertrophy was similar and stronger than the strength of the relationship between routine systolic BP and left ventricular hypertrophy.ConclusionsTaken together, these results suggest that translation of the SPRINT results will require measurement of BP as performed in that trial. Instead of an algebraic manipulation of routine clinic measurements, the SPRINT methodology of BP measurement would be needed at minimum if implementation of the SPRINT results were to be deployed in the population at large.

Blood pressure parameters are associated with all-cause and cause-specific mortality in chronic kidney disease

“…Mean age of the SPRINT study population differs from the general and this study CKD population and the observed mortality rate among CKD participants in SPRINT was much lower than our study population(9). In addition, BP was obtained in SPRINT using a standardized protocol while we utilized data collected in a clinical setting(21). …”

Validity of Cardiovascular Data From Electronic Sources

“…Findings from a single site in the Systolic Blood Pressure Intervention Trial (SPRINT) trial also found similar variability between in-clinic and research-grade measurements within the same day among a smaller, predominantly male sample with chronic kidney disease. 35 These results underscore the challenges of developing risk models using blood pressure measurements from the EHR in contrast to research-grade measurements, which at least remove most of the variability from measurement and setting. The results may also inform 1) the design of next-generation epidemiology cohorts and pragmatic clinical trials that include EHR measurements of blood pressure as part of the study design and 2) the translation of cohort-based risk scores to clinical practice.…”

Nephro Update Europe 2017

“…One important aspect is the method of blood pressure measurement, which was looked at by Agarwal [12] . In the SPRINT study, patients were seated for 5 min in a quiet room and then 3 oscillometric measurements Agarwal discovered a significant difference in result among 2 groups, those whose blood pressure was measured as in SPRINT, and those who were measured without being at seated rest.…”