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Cardiovascular highlights from non-cardiology journals

SPRINT TO LOWER BLOOD PRESSURE TARGETS Epidemiologic studies have demonstrated increasing cardiovascular risk at a systolic blood pressure above 115 mm Hg. However, blood pressure treatment targets are less clear with clinical trials limited to evidence of benefit below 150 mm Hg. The Systolic Blood Pressure Intervention Trial (SPRINT) sought to determine outcomes following treatment to a target of less than 120 mm Hg (intensive treatment) compared with a target of less than 140 mm Hg (standard treatment). The study randomized 9361 non-diabetic patients with systolic hypertension (>130 mm Hg) and at least one other cardiac risk factor. The primary outcome was a composite of major adverse cardiovascular events or cardiovascular death. The choice of pharmacological agents was not mandated, but the use of a thiazide based regimen was encouraged. At 1-year, the mean systolic blood pressures were 121.4 mm Hg in the intensive treatment group and 136.2 mm Hg in the standard treatment group. The mean number of blood pressure medications required in the intensive treatment group was 2.8 compared with 1.8 in the standard treatment group. The trial was stopped early in response to a strong signal of benefit with treatment to less than 120 mm Hg for the primary outcome (1.65% per year vs. 2.19% per year; hazard ratio 0.75; 95% confidence interval, 0.64 to 0.89; P<0.001). This benefit was observed at a median follow-up of 3.26 years. In addition, allcause mortality was lower in the intensive treatment group (hazard ratio, 0.73; 95% confidence interval 0.60 to 0.90; p=0.003). Rates of hypotension, syncope, electrolyte disturbance, and acute renal failure were higher in the intensive treatment group.