A Randomized Trial of Intensive versus Standard Blood-Pressure Control.

Pubmed ID: 26551272

Pubmed Central ID: PMC4689591

Journal: The New England journal of medicine

Publication Date: Nov. 26, 2015

MeSH Terms: Humans, Male, Female, Aged, Cardiovascular Diseases, Risk Factors, Age Factors, Middle Aged, Hypertension, Blood Pressure, Cause of Death, Practice Guidelines as Topic, Antihypertensive Agents, Goals

Grants: UL1 TR000445, UL1TR000075, P30 AG021332, UL1 TR000005, 9U54TR000017-06, A-HL-13-002-001, HHSN268200900040C, HHSN268200900046C, HHSN268200900047C, HHSN268200900048C, HHSN268200900049C, P30 GM103337, P30GM103337, UL1 TR000433, UL1 TR000439, UL1RR024134, UL1RR025752, UL1RR025755, UL1RR025771, UL1TR000002, UL1TR000003, UL1TR000005, UL1TR000050, UL1TR000064, UL1TR000073, UL1TR000093, UL1TR000105-05, UL1TR000433, UL1TR000439, UL1TR000445, UL1TR001064, UL1 TR000002, UL1 TR001064, UL1 TR000064, UL1 TR000075, UL1 RR025752, UL1 RR025771, UL1 TR000093, UL1 TR000003, UL1 TR000050, UL1 TR000073, UL1 RR025755, UL1 TR000105, UL1 RR024134, UL1 TR001427, UL1 TR001085

Authors: Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT, Wright JT, Cushman W, Oparil S, Cheung AK, Rocco M, Reboussin DM, Fine L, Kimmel P, Ryan L, Launer L, Moy C, Whelton P, Johnson KC, Bild D, Bonds D, Cook N, Cutler J, Fine L, Kaufmann P, Kimmel P, Launer L, Moy C, Riley W, Ryan L, Snyder J, Tolunay E, Yang S, Wright JT, Rahman M, Lerner AJ, Rahman M, Still C, Wiggers A, Zamanian S, Bee A, Dancie R, Cushman W, Wall B, Nichols L, Burns R, Martindale-Adams J, Berlowitz D, Clark E, Walsh S, Geraci T, Huff C, Shaw L, Oparil S, Lewis CE, Bradley V, Calhoun D, Glasser S, Jenkins K, Ramsey T, Cheung AK, Beddhu S, Chelune G, Childs J, Gren L, Randall A, Rocco M, Goff D, Rodriguez C, Coker L, Hawfield A, Yeboah J, Crago L, Summerson J, Hege A, Reboussin D, Williamson J, Ambrosius W, Applegate W, Evans G, Foy C, Freedman B, Kitzman D, Legault C, Lyles M, Pajewski N, Rapp S, Rushing S, Shah N, Sink KM, Vitolins M, Wagenknecht L, Wilson V, Perdue L, Woolard N, Craven T, Garcia K, Gaussoin S, Lovato L, Newman J, Amoroso B, Davis P, Griffin J, Harris D, King M, Lane K, Roberson W, Steinberg D, Ashford D, Babcock P, Chamberlain D, Christensen V, Cloud L, Collins C, Cook D, Currie K, Felton D, Harpe S, Howard M, Lewis M, Nance P, Perdue L, Puccinelli-Ortega N, Russell L, Walker J, Craven B, Goode C, Troxler M, Davis J, Hutchens S, Killeen AA, Lukkari AM, Ringer R, Dillard B, Archibeque N, Warren S, Sather M, Pontzer J, Taylor Z, Soliman EZ, Zhang ZM, Li Y, Campbell C, Hensley S, Hu J, Keasler L, Barr M, Taylor T, Bryan R, Davatzikos C, Nasarallah I, Desiderio L, Elliott M, Borthakur A, Battapady H, Erus G, Smith A, Wang Z, Doshi J, Townsend R, Cohen D, Huan Y, Duckworth M, Ford V, Sexton K, Wright JT, Lerner A, Rahman M, Still C, Bee A, Stokes DL, Smith S, Sunshine J, Clampitt M, Smith S, Welch B, Donahue M, Dagley A, Pennell D, Cannistraci C, Merkle K, Lewis J, Sika M, Wright C, Sabati M, Campuzano E, Martin H, Roman A, Cruz J, Nagornaya N, Coker L, Hege A, Maldjian J, Kaminsky S, Fuller D, Jung Y, Oparil S, Lewis B, Wadley V, Jenkins K, Ramsey T, Evanochko W, Roberson G, Corbitt T, Fisher W, Clements C, Weiner D, Wells A, Civiletto A, Aurigemma GP, Bodkin N, Norbash A, Lavoye M, Ellison A, Killiany R, Sakai O, Cheung A, Ambrosius W, Berlowitz D, Cushman W, Lewis B, Oparil S, Wright JT, Goff D, Sink K, Williamson J, Oparil S, Lewis CB, Glasser S, Bhatt U, Horwitz E, Navaneethan S, Rocco M, Hawfield A, Rodriguez C, Diamond M, Contreras G, Yeboah J, Muhlestein JB, Dwyer J, Weiner D, Simmons D, Chonchol M, Kramer H, Bates J, Servilla K, Slinin Y, Kirchner K, Fanti P, Wright C, Auchus A, Lerner A, Malik A, Asdaghi N, Kitzman D, Freedman B, Papademetriou V, Rehman S, Chapman A, Thomas G, Schreiber M, Navaneethan SD, Hickner J, Lioudis M, Lard M, Marczewski S, Maraschky J, Colman M, Aaby A, Payne S, Ramos M, Horner C, Rahman M, Drawz P, Raghavendra PP, Ober S, Mourad R, Pallaki M, Russo P, Raghavendra P, Fantauzzo P, Tucker L, Schwing B, Sedor JR, Horwitz EJ, Schellling JR, O'Toole JF, Humbert L, Tutolo W, White S, Gay A, Clark W, Hughes R, Wright JT, Dobre M, Still CH, Bee A, Williams M, Bhatt U, Hebert L, Agarwal A, Murphy MB, Ford N, Stratton C, Baxter J, Lykins AA, Neal AM, Hirmath L, Kwame O, Soe K, Miser WF, Sagrilla C, Johnston J, Anaya A, Mintos A, Howell AA, Rogers K, Taylor S, Ebersbacher D, Long L, Bednarchik B, Wiggers A, Long L, Schnall A, Smith J, Peysha L, Peysha L, Bednarchik B, Leach L, Tribout M, Harwell C, Ellington P, Banerji MA, Ghody P, Rambaud MV, Townsend R, Cohen D, Huan Y, Duckworth M, Ford V, Leshner J, Davison A, Vander Veen S, Gadegbeku CA, Gillespie A, Paranjape A, Amoroso S, Pfeffer Z, Quinn SB, He J, Chen J, Lustigova E, Malone E, Krousel-Wood M, Deichmann R, Ronney P, Muery S, Trapani D, Diamond M, Mulloy L, Hodges M, Collins M, Weathers C, Anderson H, Stone E, Walker W, McWilliams A, Dulin M, Kuhn L, Standridge S, Lowe L, Everett K, Preston K, Norton S, Gaines S, Rizvi AA, Sides AW, Herbert D, Hix MM, Whitmire M, Arnold B, Hutchinson P, Espiritu J, Feinglos M, Kovalik E, Gedon-Lipscomb G, Evans K, Thacker C, Zimmer R, Furst M, Mason M, Powell J, Bolin P, Zhang J, Pinion M, Davis G, Bryant W, Phelps P, Garris-Sutton C, Atkinson B, Contreras G, Suarez M, Schulman I, Koggan D, Vassallo J, Peruyera G, Rocco M, Hawfield A, Bethea C, Mayer S, Gilliam L, Pedley C, Zurek G, Baird M, Smoak MM, Williams J, Rogers S, Gordon L, Kennedy E, Belle B, McCorkle-Doomy J, Adams J, Chamberlain D, Lopez R, Janavs J, Rahbari-Oskoui F, Chapman A, Dollar A, Williams O, Han Y, Haley W, Fitzpatrick P, Blackshear J, Shapiro B, Harrell A, Palaj A, Henderson K, Johnson A, Gonzalez H, Robinson J, Tamariz L, Schulman I, Denizard J, Barakat R, Krishnamoorthy D, Greenway F, Monce R, Church T, Hendrick C, Yoches A, Sones L, Baltazar M, Pemu P, Jones C, 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Treger R, Knibloe K, Ishani A, Slinin Y, Olney C, Rust J, Fanti P, Bansal S, Dunnam M, Dyer C, Hu LL, Zarate-Abbott P, Appel L, Breitner J, Davis B, Dworkin L, Johnston K, Neaton J, Taylor A, Weir M, Yancy C

Cite As: SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC Jr, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015 Nov 26;373(22):2103-16. Epub 2015 Nov 9.

Studies:

Abstract

BACKGROUND: The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.).