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Lowering blood pressure targets could save lives ‘landmark’ trial concludes

Treating people to a target systolic blood pressure of 120mmHg significantly cut mortality and cardiovascular events when compared with treatment to the current 140mmHg target, according to preliminary findings from a large US trial that GP experts said could have major implications for general practice.

The study included people aged over 50 who had at least one cardiovascular risk factor or pre-existing kidney disease, and found a 25% relative reduction in the risk of death during the six-year follow-up among those treated intensively to reach the 120mmHg target, compared with those treated to 140mmHg.

There was also a 30% lower relative risk of cardiovascular events in the 120mmHg target group. 

The trial – dubbed the SPRINT study and sponsored by the US National Heart, Lung and Blood Institute (NHLBI) – was stopped much earlier than the original 2018 completion date because of the clear benefit in the more intensive treatment arm, the investigators said.

Dr Gary Gibbons, director of the NHLBI, said: ’This study provides potentially lifesaving information that will be useful to health care providers as they consider the best treatment options for some of their patients, particularly those over the age of 50.’

GP experts said the findings could lead to many more patients receiving antihypertensive treatment, although GPs should wait to see the final results – including the absolute risk reductions and numbers needed to treat – before changing practice.

Dr John Ashcroft, a GPSI in cardiology who practices in Derbyshire, told Pulse: ‘We have to wait for the details, but essentially it looks like it’s going to be a big landmark trial that will alter the way we fundamentally treat hypertension.’

He added that while GPs would not want to treat anyone with blood pressure above 120mmHg, ‘if their overall level of risk is high then you might consider treating them at these lower blood pressures’.

Dr Terry McCormack, secretary of the British Hypertension Society and a GPSI in cardiology in Whitby, North Yorkshire, said the findings could be a ‘game-changer’ – but questioned why the trial had been stopped so early.

Dr McCormack said: ‘We need to see the published results. This would be a major game changer if the trial is robust and closing early was justified.’

However, he added: ‘It is very surprising that it did close early and will take some explaining.’

 

Readers' comments (3)

  • The problem with studies is that if people cant tolerate the treatment they are excluded from the trial. So foisting such BP targets on the actual general public is usually impossible.

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  • Vinci Ho

    Bear in mind, one needs to estimate how much more side effect will emerge by moving the target degree by degree. Moving from 140 to 135 , 135 to 130, so forth. Logically , it should be getting harder and harder to avoid side effect . It will get even more when you move right down to 120mmHg

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  • Presumably they also excluded secondary impacts like falls as we over medicalise. Sounds like a weeze to push statins harder to me.

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