The SPRINT trial was a home run. The study showed compelling data that lowering blood pressure dramatically below what we were previously targeting was both well tolerated and yielded huge benefits to patients.
Now there are some questions to the method of blood pressure assessment and how this can be compared to previous blood pressure trials, but I believe that the BP assessment used in SPRINT is more reproducible in offices than the standardized BP typically used in trials that no one howls about (you mean your MA does not follow a 12 step checklist when checking patients in?).
One of the important corollaries that I emphasize when I teach SPRINT is that the study enrolled a very specific patient and we don’t know just how generalizable these findings are:
- 50 years of age
- Systolic blood pressure of 130 to 180 mm Hg
- Increased risk of cardiovascular events defined by one or more of the following:
- Clinical or subclinical cardiovascular disease other than stroke
- Chronic kidney disease, excluding polycystic kidney disease, with eGFR of 20 to 60
- 10-year risk of cardiovascular disease of 15% or greater on the basis of the Framing- ham risk score
- Age of 75 years or older
- Patients with diabetes mellitus or prior stroke were excluded
- Not quite as good as an aspirin in an MI, NNT of 41
- Essentially as good as the Mediterranean diet, NNT 61
- Better than a statin in patients with known heart disease, NNT 83
- and way better than CT scans for lung cancer screening, NNT 217