Sprinting toward the optimal blood pressure target for hypertensive patients

Abstract

Identifying the optimal blood pressure (BP) target for treatment of adults with high BP is a priority for healthcare providers and patients because of the high prevalence of hypertension in the population and the abundant evidence that lowering BP reduces cardiovascular disease (CVD) events and death. Treatment to a systolic BP (SBP) level below the traditional target of 140 mm Hg is desirable in most adults with hypertension who are at high risk for atherosclerotic CVD (ASCVD).1 At least 18 randomized controlled trials (RCTs) have compared CVD outcomes in participants allocated to different BP targets, and 32 RCTs have compared CVD outcomes in participants allocated to more or less intensive antihypertensive drug therapy. Meta-analyses of these trials have identified statistically significant and clinically important reductions in CVD events in those whose BP was treated to a lower goal compared with less treatment.2 Before publication of the SPRINT (Systolic Blood Pressure Intervention Trial) results, meta-analyses had reported benefit to an average achieved SBP of 133 mm Hg.3 SPRINT, alone and in combination with the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial, provides compelling evidence in support of an SBP target <120 mm Hg in adults with hypertension who are at high risk for ASCVD.4,5 As is common with landmark trials, the SPRINT results and their relevance to clinical practice have been questioned by some, as in the Viewpoint by Kjeldsen et al6 in the current issue of Circulation Research. In this Counterpoint Viewpoint, we address some of the more frequent criticisms of SPRINT.