Generalizability of SPRINT Results to the U.S. Adult Population

Bress, Adam P.; Tanner, Rikki M.; Hess, Rachel; Colantonio, Lisandro D.; Shimbo, Daichi; Muntner, Paul

doi:10.1016/j.jacc.2015.10.037

Cited by 131 publications

(92 citation statements)

References 16 publications

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“…7 Furthermore, and in contrast with the results of many previous trials, the intensively treated patients did not show a significant reduction in the risk of myocardial infarction and stroke, its outcome results being largely driven by a marked reduction in the incidence and risk of heart failure, a benefit possibly magnified by the masking effect of diuretics on this outcome, given that diuretics were predictively much more frequently used in aggressively than in standard-treated patients. 8 In addition, no patient enrolled in SPRINT had high pulse pressure, and only 23% of those in the intensive-treated group had SBP <120 mm Hg.…”

Section: The Systolic Blood Pressure Intervention Trialmentioning

confidence: 62%

“…7 Asimismo, y en contraste con los resultados de numerosos estudios anteriores, los pacientes sometidos a un tratamiento intensivo no mostraron una reducción significativa del riesgo de infarto de miocardio y accidente cerebrovascular; dicho resultado se debe, en gran parte, a una reducción notable de la incidencia y el riesgo de insuficiencia cardíaca, un beneficio que posiblemente se magnifica por el efecto enmascarado de los diuréticos sobre este desenlace, dado que los diuréticos fueron usados de manera predictiva con mucha mayor frecuencia en pacientes sometidos a tratamiento intensivo que en aquellos sometidos a tratamiento estándar. 8 Además, ningún paciente inscrito en el estudio SPRINT presentó presión diferencial alta, y sólo el 23% de aquellos en el grupo de tratamiento intensivo presentó PAS <120 mmHg.…”

Section: El Estudio Sprint (Systolic Blood Pressure Interventionunclassified

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Target Blood Pressure for Treatment

Rosei

2016

Hypertension

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Section: The Systolic Blood Pressure Intervention Trialmentioning

confidence: 62%

Section: El Estudio Sprint (Systolic Blood Pressure Interventionunclassified

Target Blood Pressure for Treatment

Rosei

2016

Hypertension

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“…13 Data from the 2007 to 2012 National Health and Nutrition Examination Survey suggest that 7.6% of the US population meet the SPRINT eligibility criteria, which equates to >16 million people. 15 Thus, a large segment of the population who could potentially benefit from more intensive BP management. However, we recommend caution in generalizing the SPRINT results, and particularly so to patients with a history of stroke for the following reasons.…”

Section: Review Of Sprint Trial 1693mentioning

confidence: 99%

Review of the Systolic Blood Pressure Intervention Trial for Hypertension Management

Silver

Anderson

2016

Stroke

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O ne of the great successes of modern medicine is the development of effective pharmacological treatments to lower blood pressure (BP). Of the modifiable risk factors for cardiovascular disease, elevated BP or hypertension has the highest population attributable risk, 1 and a near continuous relationship with rates of stroke and coronary heart disease from levels of 115 mm Hg systolic and 75 mm Hg diastolic BP.2 Overviews of randomized trials are consistent in showing that lowering systolic BP by 5 to 10 mm Hg reduces the risk of stroke by one third, irrespective of disease history, initial BP level, or type of agent used.3-5 Moreover, more intensive longterm BP lowering can result in additional benefits proportional to the size of fall in BP. [4][5][6] Despite this body of evidence, there has been longstanding controversy (and consternation) over the levels to which BP should be brought down by treatment for the prevention of cardiovascular disease. Because there has been limited randomized evidence, guideline committees have been challenged in defining BP targets below 130 to 140 mm Hg to manage individual patients.7 Concerns over diminishing net benefit being overtaking by excessive harm with increasing reductions in BP is supported by a physiological argument over critical thresholds for organ perfusion and secondary analysis of randomized trials suggesting a J-shaped relationship with cardiovascular events.8 Moreover, recent trials of more intensive BP lowering, including the Action to Control Cardiovascular Risk on Type 2 Diabetes (ACCORD) 9 and Secondary Prevention of Small Subcortical Strokes (SPS3), 10 failed to show significant reductions in rates of ischemic stroke with systolic BP reductions below 120 and 130 mm Hg, respectively.The main result of the Systolic Blood Pressure Intervention Trial (SPRINT) 11 has, therefore, created a new paradigm in hypertension management and is affecting on hypertension management guidelines around the world. The headline summary was that people at high cardiovascular risk who received more intensive BP-lowering treatment to target systolic levels below 120 mm Hg had fewer cardiovascular events than those who were treated to a target of below 140 mm Hg. For stroke physicians, the key question is whether these results apply to their patients.SPRINT was a carefully conducted clinical trial, sponsored by the National Heart, Lung and Blood Institute of the United States, that involved 9361 hypertensive patients (mean age, 68 years) who were treated to 2 systolic BP treatment targets (<120 versus <140 mm Hg). The key inclusion criteria were an age ≥50 years, systolic BP of 130 to 180 mm Hg, and evidence of increased cardiovascular risk based on either a 10-year Framingham risk estimate of at least 15% or markers of vascular disease including chronic renal disease in approximately one third of participants; but people with diabetes mellitus or stroke were specifically excluded. The study was stopped earlier than planned after a mean follow-up of 3.26 years, on the recommend...

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“…Desde el anuncio de los resultados preliminares (11 de septiembre) 5 , la publicación en línea (09 de noviembre) y oficial (26 de noviembre) 4 , el SPRINT ha generado un gran impacto en el mundo publicándose editoriales 6---10 , comentarios, revisiones sistemáticas/metaanálisis 11 , estudios transversales 12 , análisis secundarios de estudios previos (ACCOMPLISH) 13 , e incluso evaluándose la detención/continuación del ensayo clínico en ejecución ESH-CHL-SHOT 14 . Estos estudios han abordado desde diversas perspectivas la relevancia, utilidad, aplicabilidad y aspectos controversiales del SPRINT, relacionados con la PA meta ideal o alcanzada, los efectos adversos más frecuentes (hipotensión, síncope, hiponatremia, hipopotasemia, etc.)…”

Section: Impacto Del Sprint: Control Intensivo De La Presión Arterialunclassified