SOURCE: Böhm M, Schumacher H, Teo KK, et al. Lancet 2017;389:2226-2237.

The authors of the Systolic Blood Pressure Intervention Trial (SPRINT) randomized almost 10,000 high-risk, non-diabetic patients to intensive treatment (systolic blood pressure [SBP] goal: < 120 mmHg) vs. “standard” treatment (SBP goal: < 140 mmHg) and demonstrated that the group assigned to intensive treatment experienced a statistically significant reduction in both cardiovascular (CV) and all-cause mortality. Although the “costs” of intensive treatment were not trivial (more medications, more cost, more serious and non-serious adverse events), the lesson for many clinicians was that striving for SBP control better than < 120 mmHg was of merit in patients willing to shoulder the increased complexity and potential adverse effect profile of intensive treatment. But this may not be the end of the story.

Böhm et al analyzed the outcomes of two large, previously published CV trials: ONTARGET (n = 25,127) and TRANSCEND (n = 5,810). They chose to examine CV outcomes within these two trials for patients similar to the SPRINT population (high-risk adults) in relation to on-treatment BP. According to their analysis, achieving an SBP < 120 mmHg was associated with a 14% increase in composite CV outcomes compared to an SBP 120-140 mmHg. Similarly, hazard ratios for all-cause mortality and CV mortality were approximately 30% higher in persons who achieved the lower BP threshold (< 120 mmHg).

While these results might dampen enthusiasm for those who endorse the above-mentioned results of SPRINT, differences between the data sets, as well as the fact that this report relies on post-hoc analysis, include a substantial proportion of diabetics and post-stroke patients in the analysis of ONTARGET/TRANSCEND, both of whom had been excluded from SPRINT, and may have made an important difference in outcomes.