In 2015, published results from the landmark Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive blood pressure management reduced cardiovascular disease and lowered the risk of death. In 2019, results from the SPRINT MIND trial showed that lowering blood pressure also reduced the risk of mild cognitive impairment in older people.
Now, researchers at Wake Forest University School of Medicine have shown that while intensive blood pressure control benefited the health of SPRINT participants during the trial, the benefits for cardiovascular mortality disappeared after about two years, when blood pressure management protocols were no longer being followed.
The study results are published online in JAMA Cardiology.
We wanted to examine the long-term effect of intensive SPRINT treatment. The results are disappointing, but not surprising. If you have high blood pressure, controlling it is a lifetime commitment. »
Nicholas Pajewski, Ph.D., associate professor of biostatistics and data science, Wake Forest University School of Medicine and corresponding author of the study.
The SPRINT trial, led by David Reboussin, Ph.D., professor of biostatistics and data science at Wake Forest University School of Medicine, confirmed that in adults 50 and older with high blood pressure, the Targeting systolic blood pressure below 120 millimeters of mercury (mm Hg) reduced rates of cardiovascular events, such as heart attacks and heart failure, as well as strokes by 25%. This goal also reduced the risk of death by 27%, compared to a target systolic pressure of 140 mm Hg.
The study began in the fall of 2009 and included more than 9,300 participants aged 50 and older, recruited from approximately 100 medical centers and clinical practices across the United States and Puerto Rico. Participants were randomly assigned to a systolic blood pressure goal of less than 120 mm HG (intensive treatment) or less than 140 mm HG (standard treatment). The National Institutes of Health (NIH) stopped the blood pressure intervention ahead of schedule to quickly release significant preliminary results, resulting in a new set of guidelines for blood pressure control.
In the latest study, Pajewski and team linked participants to the National Death Index from 2016 to 2020, which added 4.5 years of mortality follow-up after the trial concluded. They also reviewed trial participants’ electronic health records for outpatient blood pressure measurements.
“In addition to the diminishing benefit of intensive treatment on cardiovascular mortality, we found a gradual increase in blood pressure among participants in the intensive treatment group such that, four or five years after the trial, it no longer seemed to be there. have a difference in systolic blood pressure between the groups,” Pajewski said. ” The message is clear. Sustained blood pressure control is necessary to continue to reduce the burden of fatal cardiovascular events. »
SPRINT was co-sponsored by the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke, and the National Institute of Aging. The study was supported by NIH grants R01HL136679, R01AG055606, and R01AG065805.
Source :
Atrium Health Wake Forest Baptist
Journal reference:
Jaeger, B.C., et al. (2022) Longer-Term All-Cause and Cardiovascular Mortality With Intensive Blood Pressure Control A Secondary Analysis of a Randomized Clinical Trial. JAMA Cardiology. doi.org/10.1001/jamacardio.2022.3345.