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Under Pressure: Hypertension Management after

SPRINT (Systolic Blood Pressure

Intervention Trial)

Janelle Billig, MD

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Understand the key conclusions from the 2015 SPRINT study (Systolic Blood

Pressure Intervention Trial)

Compare the data from SPRINT trial to JNC8 recommendations

Identify patients in your practice who may benefit from lower BP goals based on

SPRINT evidence

Objectives

Understand the key conclusions from the 2015 SPRINT study (Systolic Blood

Pressure Intervention Trial)

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Hypertension Studies Timeline

Saklayen MG, Deshpande NV. Timeline of History of Hypertension Treatment. Front Cardiocasc Med. 2016 Feb 23;3:3

1967 2015

JNC8 JNC7

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2003 2009 2010 2014 2015

Paper JNC7 Cochrane ACCORD JNC8 SPRINT

Main

points

<140

<130 if

DM/CKD

No benefit

lower BP goal

No benefit <140

in DM or hx of

CVA

Liberalized

<140

<150 if >60y

Caveat Expert

opinion

*MAP or DBP,

No studies

specific to SBP

underpowered? Expert

opinion

Question remained:

Is there benefit for lower SBP goals in

non-diabetics with CV risk?

Question remained:

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Major Conclusions

Lower SBP goal to 120 mmHg in

non-diabetic adults with CV risk

Reduces CV adverse events

Reduces all-cause mortality

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SPRINT Controversies

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Adverse Events

Other Notable:

● No difference in falls

● More medications

● More clinic visits

● Cost?

● Quality of life?

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Feasible?

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Meds Visits

1.8

2.8 20-30%

more

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Focus too much on medication intervention?

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Generalizable?

Low CVD risk pts?

Patients with CKD?

Diabetics?

Geriatric?

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Objectives

Understand the key conclusions from the 2015 SPRINT study (Systolic Blood

Pressure Intervention Trial)

Compare the data from SPRINT trial to JNC8 recommendations

Identify patients in your practice who may benefit from lower BP goals based on

SPRINT evidence

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ACCORD vs SPRINT = Diabetics vs. Non-Diabetics

Cushman, et al SPRINT Trial: Latest News in Hypertension Management. Hypertension. 2016;67:263-265

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JNC8 vs SPRINT

2010 2014 2015

Paper ACCORD JNC8 SPRINT

Main point No benefit <140 in

DM or hx of CVA

Liberalized goals

Lower goal improves CV

outcome

SBP Goal

Recommended

50y+ <140 (+ CV risk): <120

60y+ <150 (+ CV risk): <120

Diabetic <140 <140 No comment

CKD <140 Pending

Caveat Underpowered? Expert opinion Stopped early

Increase in some types

adverse outcomes

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Objectives

Understand the key conclusions from the 2015 SPRINT study (Systolic Blood

Pressure Intervention Trial)

Compare the data from SPRINT trial to JNC8 recommendations

Identify patients in your practice who may benefit from lower BP goals based on

SPRINT evidence

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Which patients would benefit from intensive SPRINT goal?

55-yr old man with ASCVD risk score of 18%:

YES

62-yr old man with diabetes and microalbuminuria

MAYBE

69-yr old woman with hx of stroke.

MAYBE

78-yr old man BP 180/90

MAYBE

75-yr old woman with HTN, CKD stage 2,

occasional orthostatic hypotension

MAYBE

45-yr old woman, smoker, with ASCVD risk 15%

MAYBE

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Future Steps for SPRINT (or the marathon)

● Final data collection through 2016

○ Quality of Life sub-group

analysis

○ CKD subgroup analysis

● BP control effects on

○ Dementia

○ Cognitive Function

○ Cerebral Small Vessel Disease

● JNC9?

● Cochrane review?

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Objectives Review

Understand the key conclusions from the 2015 SPRINT study (Systolic Blood Pressure Intervention

Trial)

● SBP goal of 120 reduced CV events and mortality in those >50 at increased CV risk

● Some increase in adverse events of AKI, hypotension

Compare the data from SPRINT trial to JNC8 recommendations

● JNC8 liberalized goals, SPRINT is more strict

● JNC is consensus statement, SPRINT is one RCT (large, powerful)

Identify patients in your practice who may benefit from lower BP goals based on SPRINT evidence

● Consider your adult patients with CV risk factors and low risk of adverse events

● Reasonable to wait and see how future guidelines shift after SPRINT

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References

• SPRINT Research Group: Wright JT Jr, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus

standard blood pressure control. N Engl J Med 2015 373:2103-2116

• Saklayen MG, Deshpande NV. Timeline of History of Hypertension Treatment. Front Cardiovasc Med. 2016 Feb

23;3:3

• Bress et al. Generalizability of SPRINT Results. JACC 2016; 67(5): 463-72

• Thomas G, et al. Interpreting SPRINT: How low should you go? Cleveland Clinic Journal of Medicine 2016 83(3):

187-195

• Cushman, et al SPRINT Trial: Latest News in Hypertension Management. Hypertension. 2016;67:263-265

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Questions??