Wow! This is the first wordI think of to describe therecent announcement ofthe early termination of the SystolicBlood Pressure Intervention Trial(SPRINT) sponsored by the NationalInstitutes of Health (NIH).
The studybegan in the fall of 2009 and includedmore than 9,300 participants aged50 years and older from about 100medical centers in the United Statesand Puerto Rico. The study specificallyexcluded individuals with diabetes mellitus, prior stroke, andpolycystic kidney disease. Patient inclusion criteria included a systolic blood pressure (BP) greater than 130 mm Hg and one of the following:a history of cardiovascular disease or subclinical cardiovascular disease,an estimated glomerular filtration rate of 20–59 mL/min/1.73 m2 orage 75 years or older, or a 10-year Framingham cardiovascular diseaserisk score greater than 15%.
The trial looked at a target systolic BP of120 mm Hg versus 140 mm Hg. The results were impressive: The riskof death was decreased by almost 25%, and the risk of cardiovascularevents was decreased by almost one-third. This is clearly a landmarktrial that will have a clinical impact similar to that of earlier studiesof ACE inhibitors in diabetic nephropathy.
A press release issued by the NIH gives us reason for enthusiasm,but we must learn more about the results before we apply them to ourclinical practice. It will be especially important for nephrologists tosee treatment effects specifically in the large subgroup with chronic kidney disease as compared to the elderly subgroup.
Application ofwhat we learn from this trial will improve the health of our patientsbut also make our jobs quite a bit harder. Achieving a systolic BP lessthan 120 mm Hg requires more medication, better balancing of sideeffects, and more careful evaluation of patients to avoid hypotension.I think it will be difficult to attain this goal without having patientsmeasure their BP frequently at home and being more involved in theircare. SPRINT included individuals who were motivated to be in aclinical trial; many of our patients will not have the same enthusiasm,and we will have to inspire them as well.
Congratulations! This is the second word I think of when I thinkof SPRINT. Congratulations to the many patients and investigators(including my colleagues here at Wake Forest and many readers ofRenal & Urology News) who worked over the past 5 years on thisimportant trial. The results will have a tremendous impact on thehealth of millions of patients.
Anthony Bleyer, MD, MSProfessor of Internal Medicine/NephrologyWake Forest University School of MedicineWinston-Salem, N.C.