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Under Pressure: Hypertension Management after
SPRINT (Systolic Blood Pressure
Intervention Trial)
Janelle Billig, MD
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Understand the key conclusions from the 2015 SPRINT study (Systolic Blood
Pressure Intervention Trial)
Compare the data from SPRINT trial to JNC8 recommendations
Identify patients in your practice who may benefit from lower BP goals based on
SPRINT evidence
Objectives
Understand the key conclusions from the 2015 SPRINT study (Systolic Blood
Pressure Intervention Trial)
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Hypertension Studies Timeline
Saklayen MG, Deshpande NV. Timeline of History of Hypertension Treatment. Front Cardiocasc Med. 2016 Feb 23;3:3
1967 2015
JNC8 JNC7
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2003 2009 2010 2014 2015
Paper JNC7 Cochrane ACCORD JNC8 SPRINT
Main
points
<140
<130 if
DM/CKD
No benefit
lower BP goal
No benefit <140
in DM or hx of
CVA
Liberalized
<140
<150 if >60y
Caveat Expert
opinion
*MAP or DBP,
No studies
specific to SBP
underpowered? Expert
opinion
Question remained:
Is there benefit for lower SBP goals in
non-diabetics with CV risk?
Question remained:
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Major Conclusions
Lower SBP goal to 120 mmHg in
non-diabetic adults with CV risk
Reduces CV adverse events
Reduces all-cause mortality
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SPRINT Controversies
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Adverse Events
Other Notable:
● No difference in falls
● More medications
● More clinic visits
● Cost?
● Quality of life?
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Feasible?
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Meds Visits
1.8
2.8 20-30%
more
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Focus too much on medication intervention?
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Generalizable?
Low CVD risk pts?
Patients with CKD?
Diabetics?
Geriatric?
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Objectives
Understand the key conclusions from the 2015 SPRINT study (Systolic Blood
Pressure Intervention Trial)
Compare the data from SPRINT trial to JNC8 recommendations
Identify patients in your practice who may benefit from lower BP goals based on
SPRINT evidence
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ACCORD vs SPRINT = Diabetics vs. Non-Diabetics
Cushman, et al SPRINT Trial: Latest News in Hypertension Management. Hypertension. 2016;67:263-265
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JNC8 vs SPRINT
2010 2014 2015
Paper ACCORD JNC8 SPRINT
Main point No benefit <140 in
DM or hx of CVA
Liberalized goals
Lower goal improves CV
outcome
SBP Goal
Recommended
50y+ <140 (+ CV risk): <120
60y+ <150 (+ CV risk): <120
Diabetic <140 <140 No comment
CKD <140 Pending
Caveat Underpowered? Expert opinion Stopped early
Increase in some types
adverse outcomes
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Objectives
Understand the key conclusions from the 2015 SPRINT study (Systolic Blood
Pressure Intervention Trial)
Compare the data from SPRINT trial to JNC8 recommendations
Identify patients in your practice who may benefit from lower BP goals based on
SPRINT evidence
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Which patients would benefit from intensive SPRINT goal?
55-yr old man with ASCVD risk score of 18%:
YES
62-yr old man with diabetes and microalbuminuria
MAYBE
69-yr old woman with hx of stroke.
MAYBE
78-yr old man BP 180/90
MAYBE
75-yr old woman with HTN, CKD stage 2,
occasional orthostatic hypotension
MAYBE
45-yr old woman, smoker, with ASCVD risk 15%
MAYBE
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Future Steps for SPRINT (or the marathon)
● Final data collection through 2016
○ Quality of Life sub-group
analysis
○ CKD subgroup analysis
● BP control effects on
○ Dementia
○ Cognitive Function
○ Cerebral Small Vessel Disease
● JNC9?
● Cochrane review?
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Objectives Review
Understand the key conclusions from the 2015 SPRINT study (Systolic Blood Pressure Intervention
Trial)
● SBP goal of 120 reduced CV events and mortality in those >50 at increased CV risk
● Some increase in adverse events of AKI, hypotension
Compare the data from SPRINT trial to JNC8 recommendations
● JNC8 liberalized goals, SPRINT is more strict
● JNC is consensus statement, SPRINT is one RCT (large, powerful)
Identify patients in your practice who may benefit from lower BP goals based on SPRINT evidence
● Consider your adult patients with CV risk factors and low risk of adverse events
● Reasonable to wait and see how future guidelines shift after SPRINT
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References
• SPRINT Research Group: Wright JT Jr, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus
standard blood pressure control. N Engl J Med 2015 373:2103-2116
• Saklayen MG, Deshpande NV. Timeline of History of Hypertension Treatment. Front Cardiovasc Med. 2016 Feb
23;3:3
• Bress et al. Generalizability of SPRINT Results. JACC 2016; 67(5): 463-72
• Thomas G, et al. Interpreting SPRINT: How low should you go? Cleveland Clinic Journal of Medicine 2016 83(3):
187-195
• Cushman, et al SPRINT Trial: Latest News in Hypertension Management. Hypertension. 2016;67:263-265
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Questions??