The NIH sponsored SPRINT trial was published in NEJM November 2015. It uncovered that adults with increased risk of cardiovascular disease, but without diabetes, performed better when systolic BP was < 120 mmHg rather than < 140 mmHg. Cardiovascular events and mortality were about 25% less in participants with tighter systolic blood pressure control. About 9,000 patients were followed for 5 years.
Secondary analysis of the SPRINT study shows that patient-reported outcomes – physical activity, mental function, depression score and treatment satisfaction – were similar among adults with final sBP < 120 mmHg and those with sBP < 140 mmHg.
What would be your systolic blood pressure goal for a 57 year old male smoker without diabetes?
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Background: The previously published results of the Systolic Blood Pressure Intervention Trial showed that among participants with hypertension and an increased CVD risk, but without diabetes, the rates of cardiovascular events were lower among those who were assigned to a target systolic blood pressure of < 120 mm Hg (intensive treatment) than among those who were assigned to a target < 140 mm Hg (standard treatment). Whether such intensive treatment affected patient-reported outcomes was uncertain; those results from the trial are reported here.
Methods: We randomly assigned 9,361 participants with hypertension to a systolic blood-pressure target < 120 mm Hg or a target < 140 mm Hg. Patient-reported outcome measures included the scores on the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Veterans RAND 12-Item Health Survey, the Patient Health Questionnaire 9-item depression scale (PHQ-9), patient-reported satisfaction with their blood-pressure care and blood-pressure medications, and adherence to blood-pressure medications. We compared the scores in the intensive-treatment group with those in the standard-treatment group among all participants and among participants stratified according to physical and cognitive function.
Results: Participants who received intensive treatment received an average of one additional antihypertensive medication, and the systolic blood pressure was 14.8 mmHg lower in the group that received intensive treatment than in the group that received standard treatment.
Mean PCS, MCS, and PHQ-9 scores were relatively stable over a median of 3 years of follow-up, with no significant differences between the two treatment groups.
No significant differences between the treatment groups were noted when participants were stratified according to baseline measures of physical or cognitive function.
Satisfaction with blood-pressure care was high in both treatment groups, and we found no significant difference in adherence to blood-pressure medications.
Patient-reported outcomes among participants who received intensive treatment, which targeted a systolic blood pressure < 120 mm Hg, were similar to those among participants who received standard treatment, including among participants with decreased physical or cognitive function.