23 juin 2016
SPRINT? : A Randomized Trial of Intensive versus Standard Blood-Pressure Control
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 Nov 26 ;373(22):2103-16. 26551272
The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain.
We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes.
At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs.? 2.19% per year ; hazard ratio with intensive treatment, 0.75 ; 95% confidence interval [CI], 0.64 to 0.89 ; P<0.001). All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73 ; 95% CI, 0.60 to 0.90 ; P=0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensive-treatment group than in the standard-treatment group.
Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. (Funded by the National Institutes of Health ; ClinicalTrials.gov number, NCT01206062.).
Williamson JD, Supiano MA, Applegate WB, et al. ; SPRINT Research Group. Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ?75 Years : A Randomized Clinical Trial. JAMA. 2016 Jun 28 ; 315(24):2673-82. 27195814
Ambrosius WT, Sink KM, Foy CG, et al. ; SPRINT Study Research Group. The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure : the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Trials. 2014 Oct ; 11(5):532-46. 24902920
Chang TI, Evans G, Cheung AK, et al. ; SPRINT Study Research Group. Patterns and Correlates of Baseline Thiazide-Type Diuretic Prescription in the Systolic Blood Pressure Intervention Trial. Hypertension. 2016 Mar ; 67(3):550-5. 26865200