Major hypertension trial stopped early for positive benefit with lower blood pressure control target
American Heart Association comment on SPRINT trial results
DALLAS – Sept. 11, 2015 – The National Institutes of Health (NIH) today reports that, for people age 50 and older with high blood pressure and at least one other risk factor for heart disease, lowering blood pressure to under 120 mm Hg reduced a combined end point of heart attack, acute coronary syndrome, heart failure and strokes by 30% more than lowering it to 140 mm Hg. In addition, deaths from any cause were reduced by 25% in those treated to reach a goal of 120 mm Hg. The study's independent data safety and monitoring board called for the study to be halted because of this significant benefit, which clearly outweighed any harm.
The report, which comes from a preliminary look at data from the 9,300 person, NIH-funded SPRINT study, comes at a time when there is debate among the scientific community about treatment targets for people with high blood pressure. The current guidance from the American Heart Association and American College of Cardiology state that most people with high blood pressure should aim for a systolic pressure (the top number in a reading) of lower than 140 mm Hg and those with additional risk factors such as diabetes or kidney disease should aim for levels under 130.
The AHA maintained its recommendation of 140 mm Hg for most adults, even in light of a writing committee made up of individuals originally empaneled to write national blood pressure guidelines who published a statement calling for those guidelines to be relaxed. Last fall, the committee called for treatment target of 150 mmHg for people older than 60, suggesting a lack of scientific evidence for a lower target, but not considering studies with stroke as an end point.
“Previously, the AHA cited a serious concern that we might see a reverse in the decades-long decline in rates of heart disease and stroke if a higher target was put into practice,” said Mark A. Creager, M.D. president of the American Heart Association. “The preliminary results from the SPRINT study validate the association’s position on blood pressure that a lower goal is better.”
The AHA identifies a blood pressure measure of 120 mm Hg as ideal in its Life's Simple 7 initiative. One in three American adults has high blood pressure, and it’s underdiagnosed and undertreated among all races and genders. Individuals with high blood pressure often become patients treated for serious cardiovascular problems such as stroke, heart attack or heart failure. We must maintain an aggressive stance to continue fighting this silent killer.
The ACC/AHA Taskforce on Practice Guidelines has already begun the review process, in partnership with the NHLBI, to update the national blood pressure guidelines for clinicians to follow as the national standard for hypertension prevention and treatment. The SPRINT findings will factor in to decision-making for the updated guidance. We eagerly anticipate the publication of the details of SPRINT over the next several months, so that they can be considered by the writing group.
For information on high blood pressure visit heart.org/hbp
