SPRINT supports stringent BP goals for elderly

By Eleanor McDermid

Analysis of SPRINT participants older than 75 years shows that they too benefitted from an intensive blood pressure (BP) target of 120 mmHg.

The SPRINT (Systolic Blood Pressure Intervention Trial) subanalysis, which is published in JAMA, was preplanned and had sufficient statistical power to detect a treatment effect in participants over the age of 75 years, 2510 of whom were included in this analysis.

Editorialist Aram Chobanian (Boston University Medical Center, Massachusetts, USA) hails SPRINT as "an important study that should have a substantial influence on future clinical practice."

During a median follow-up of 3.14 years, patients randomly assigned to the intensive BP target group attained an average BP of 123.4 mmHg, compared with 134.8 mmHg among those treated to the standard 140 mmHg target.

The primary outcome was a composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, heart failure and vascular mortality. This occurred at a rate of 2.59% per year in the intensive treatment group versus 3.85% in the standard treatment group, giving a significant 34% reduced risk in the intensive treatment group.

Likewise, there was a 33% reduced risk of death from any cause, report Jeff Williamson (Wake Forest School of Medicine, Winston-Salem, North Carolina, USA) and study co-authors. And an exploratory analysis indicated that patients' frailty did not impact the effectiveness of treatment.

The team notes, however, that the findings cannot be applied to patients who have Type 2 diabetes, prevalent stroke or symptomatic heart failure, or who live in a nursing home, because these patients were excluded from the study.

Serious adverse events occurred at similar rates in both treatment groups. The rate of hypotension was slightly, but not significantly, higher in the intensive treatment group than the standard treatment group (2.4 vs 1.4%), and the same was true for syncope (3.0 vs 2.4%) and electrolyte abnormalities (4.0 vs 2.7%).

In his editorial, Chobanian notes that many physicians still have concerns about lowering BP in elderly patients - not helped by the conflicting advice in society guidelines.

He concedes that it may be challenging for physicians to achieve intensive BP goals in older patients, but says that the SPRINT findings "cannot be discounted, and unless unexpected adverse effects are observed on further examination of the trial data, then major changes in treatment goals for patients 75 years or older with hypertension will be warranted."

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