By Harold Szerlip, MD MS(ED), FACP, FCCP, FASN, FNKF, CCRP
Get ready for a significant change in the hypertension guideline. The SPRINT trial, which compared intensive treatment for hypertension (< 120 mm Hg systolic) to the present guidelines (< 140 mm Hg) was terminated early by the data safety monitoring committee because of a > 25 percent decrease in cardiovascular events in the intensive treated arm. With these findings, the present guidelines are currently being rewritten.
Patients recruited for the Trial were older than 50 and had to have a 10-year CV risk of 15 percent as defined by a Framingham risk score. Importantly, patients were EXCLUDED if they were diabetic, had suffered a stroke, were in a nursing home, had an ejection fraction < 35%, an eGFR <20, or > 1 gram of proteinuria. Of note, the average number of BP meds at recruitment was only 1.8. BP was measured using an automated device that took three measurements without a clinician present. This likely represents a 5-10 mm lower BP than routine office measurement.
In the defined populations clinicians will be expected to aim for this new target. This means:
- Measuring BP using the methodology of the study
- Increasing the number of BP medications used
- Increasing the number of clinic visits to achieve these goals
- Possibly initiating treatment in patients defined previously as having pre-hypertension
The good news is the lower goal BP will improve outcomes in our patients. Unfortunately, the bad news is we were only able to achieve the old goals in 50 percent of our patients.