Is 120 mm Hg the new BP target? What headlines aren't telling you

AMA Wire
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The results of the SPRINT trial are in, and you’ve probably heard that making 120 mm Hg the new blood pressure target helped lower mortality rates. Yet the study outcomes apply only to a specific subset of patients with hypertension. See whether or not your patients may fit into this category.

In the much-anticipated results of the SPRINT trial, the relative risk of death from cardiovascular causes was 43 percent lower for patients receiving more intensive treatment for a 120 mm Hg target versus those who received standard treatment for a 140 mm Hg target.

While these results were unexpected and are noteworthy, what you won’t see in much of the news that summarizes this study is that these benefits only apply for patients who meet the same criteria used for study participants. In fact, five out of six patients currently being treated for hypertension do not meet the criteria of the study—and therefore wouldn’t benefit from its results.

In order to participate in the trial, patients needed to meet these eligibility criteria:

  • Are at least 50 years old (the average age was nearly 69)
  • Have systolic blood pressure of 130-180 mm Hg
  • Have high risk of a cardiovascular event (one or more of the following):
  1. Cardiovascular disease other than stroke
  2. Chronic kidney disease
  3. A Framingham Risk Score for 10-year cardiovascular disease risk above 15 percent (but the study mean was 20 percent)
  4. Be 75 years or older
  • Have not had a stroke
  • Not have diabetes

What should you do with these results?

The simple answer: Don’t do anything yet. Associated with a lower target blood pressure were increased adverse events, including kidney failure, low blood pressure and loss of consciousness. Patients who do not meet the eligibility criteria may be exposed to the harms and possibly not the benefits and should continue their course of treatment.

Luckily, the SPRINT results have been released in time for the American Heart Association (AHA) and American College of Cardiology writing group to consider them for the much-anticipated guideline on the management of hypertension, which will be released sometime next year.

More cardiovascular news and resources

Coinciding with the AHA Scientific Sessions earlier this week, JAMA released a special theme issue on cardiovascular disease. Among various topics, the issue digs into the potential implications of recently approved PCSK-9 inhibitors, screening for atrial fibrillation, treating exercise as a “dose” of medicine and an investigation into the common problem of the assessing patients with chest pain.

Also at the Scientific Sessions, the AMA and AHA announced Target: BP, a joint initiative to help improve outcomes around heart disease. The initiative is designed to address the growing burden of high blood pressure and help physicians and patients improve health outcomes by achieving better blood pressure control.

Additional resources that can help you ensure your patients receive the treatment they need to get their blood pressure under control include:

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Comments

I am restful. Thank you.
Seems odd. Most studies have inclusiona and exclusion criteria. Many studies exclude women. To say that the results of the blood pressure study apply only to the people who fit the inclusion criteria is odd. The same can be said for most all studies (and maybe should be). Perhaps is meant the inclusion criteria is too narrow to generalize. But maybe not. HT is more prevalent in older people. It is a major risk factor for heart disease. It is involved in many conditions prevalent in the elderly. Lets see what the AMA and AHA say.
The authors comments in this article are inappropriate. The target of 120mmHg MAY not apply to your patient, but just because your patient does not meet the inclusion criteria for patients in the study, does not necessarily indicate that this BP goal will not be of benefit...it means that we don't know...yet. Take the recommendations in this article with a grain of salt.
SPRINT is a landmark study and it will change how we manage HTN for "older" folks in general. As an ASH specialist who manages predominantly elderly folks with resistant HTN and multiple comorbidities, I would suggest we continue to follow the wisdom of perhaps the greatest pioneer of HTN of our time, Dr. Marvin Moser, who used to tell us to "start low and go slow" with antihypertensive meds when managing the elderly, especially those of extreme age, given their propensity for orthostasis, autonomic dysfunction, unintentional medication non-adherence, etc. Of course, being aware of and incorporating EBM, especially landmark trials, is very important in managing one's patients, but one musn't overgeneralize their approach to a particular population and forget there is an individual sitting in front of you.
I think<br/> TRUST NO ONE.
This is to Feed Big Pharma!! Who Did this Study Anyhow?
The best thing about JNC 8 is that it finally recognized something that had been apparent for years: lowering elderly BP to 120 resulted in dizziness and falls. It is therefore with much apprehension that I see a study that suggests I should overtreat patients who are much more likely to end up dead or debilitated from a hip fracture if they get dizzy, than to have an MI or stroke because their BP was 135/85 instead of 120/70. I intend to make no changes in my practice unless further validation occurs.
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Sep 19, 2018
Medication-assisted treatment and inpatient care are among approaches that work, but many states still only offer minimal care for a massive problem.