Should Patients With Cardiovascular Risk Factors Receive Intensive Treatment of Hypertension to

Abstract

Opposing Viewpoint, see p 1311 On the basis of the main results of the SPRINT (Systolic Blood Pressure Intervention Trial), we strongly believe that older hypertensive patients at high cardiovascular risk should receive intensive treatment to a target systolic blood pressure (SBP) of <120 mm Hg.1,2 SPRINT tested the hypothesis that intensive treatment of SBP to a target of <120 mm Hg would reduce clinical events more than standard treatment to a target of <140 mm Hg. SPRINT enrolled persons ≥50 years of age with an SBP from 130 to 180 mm Hg (treated or untreated) and at high cardiovascular risk. In particular, SPRINT overenrolled high-risk subgroups, including those ≥75 years of age (SPRINT-Senior), blacks, and those with chronic kidney disease or cardiovascular disease. The mean 10-year Framingham cardiovascular disease risk score for all participants was 20%. SBP fell rapidly in the intensive-treatment group (target SBP <120 mm Hg), reaching a level ≈15 mm Hg lower than in the standard group at 1 year (121.4 vs 136.7 mm Hg) with administration of an average of 1 more antihypertensive medication. The SPRINT intervention was stopped early (median 3.26 years of follow-up) because of a 25% reduction in the primary composite end point (myocardial infarction, non–myocardial infarction acute coronary syndrome, stroke, acute decompensated heart failure, and cardiovascular death) and a 27% reduction in all-cause mortality in the intensive-treatment group. The effects of the intensive intervention on the primary outcome and all-cause mortality were consistent across all prespecified subgroups (presence or absence of previous cardiovascular disease or chronic kidney disease, male or female sex, black or nonblack race, ≥75 or <75 years of age, and baseline SBP tertile). The benefits of intensive treatment were numerically greater (34% reduction in the primary outcome and 33% reduction in all-cause …