How Low Should We Go With Blood Pressure?

Abstract

Traditional blood pressure (BP) measurement has made its time. We should familiarize ourselves with automated unattended BP measurements. This method will virtually eliminate the BP rise associated with the presence of doctors or even nurses. Using such a protocol in patients who meet the SPRINT (Systolic Blood Pressure Intervention Trial) inclusion/exclusion criteria, a blood pressure target of ≤120 mm Hg will lead to an important reduction in the risk of stroke and heart attack. The SPRINT (Systolic Blood Pressure Intervention Trial), ClinicalTrials.gov number, NCT01206062, funded by the National Institutes of Health, is a landmark trial that, for the reasons outlined below, is expected to change our clinical approach to the management of hypertensive patient.1 The authors of this article believe that SPRINT significantly contributed to the progress of cardiovascular medicine although some implications of the study need to be assessed judiciously. To substantiate our opinion that BP goals should be reassessed lower after SPRINT, we will try to briefly summarize what SPRINT shows, what it confirms, and what it adds to existing knowledge. The SPRINT trial randomized 9361 treated or untreated hypertensive patients with systolic BP of 130 to 180 mm Hg at entry and high cardiovascular risk to a systolic BP goal of 15%, subclinical cardiovascular disease defined by left ventricular hypertrophy or abnormal ankle brachial index or coronary artery calcium score, glomerular filtration rate 20 to 59 mL/min per 1.73 m2, or age ≥75 years.1 The main exclusion criteria were diabetes mellitus, previous stroke, 1-minute standing systolic BP of <110 mm Hg, heart failure (HF), polycystic kidney disease, …