Preventing Heart Failure by Treating Systolic Hypertension: What Does the SPRINT Add?

Abstract

Previous trials definitively established that lowering systolic blood pressure (BP) to 140mmHg prevented heart failure (HF) exacerbations, but the potential benefits and risks of further BP reduction remain unclear due to a paucity of trial-based data. A recent secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) found that in older, high-risk, non-diabetic participants with systolic hypertension, a BP treatment target < 120mmHg resulted in a 36% lower rate of acute decompensated HF as compared with a BP target < 140mmHg. Those participants with incident HF had a 26-fold increased risk of subsequent cardiovascular events and death. Based in part on the SPRINT results, the 2017 American Heart Association/American College of Cardiology/HF Society Guideline for the Management of HF acknowledged that targeting a significant reduction in BP in those at increased risk for cardiovascular disease is a novel risk-based strategy to prevent HF. SPRINT redefines systolic BP target goals in older, high-risk patients and provides a key opportunity for preventing HF in this patient group.