Is SPRINT Study enough to review hypertension guidelines?
Abstract
The aim of the Systolic Blood Pressure Intervention Trial (SPRINT) was to evaluate whether setting the therapeutic goal for systolic blood pressure (SBP) at <120 mm Hg could reduce cardiovascular events (CVD) compared to the target <140 mm Hg. The study was promoted and funded by several areas at the US National Institute of Health and the collaboration of the US Veterans Administration. The results showed benefits in the intensive treatment group with a reduction in the incidence of cardiovascular events and mortality that exceeded the increase in adverse events, both in the total population and in the participants with chronic kidney disease. The substudies aimed to left ventricular hypertrophy, low diastolic blood pressure, cognitive impairment, and quality of life showed similar results. Several epidemiological studies showed that 30% of cardiovascular risk occurs in people whose SBP is between 115 and 140 mm Hg. These characteristics influenced the new guidelines developed by several scientific societies in the USA to modify the classification of blood pressure levels and therapeutic recommendations, generating a controversy that still continues. This review describes some concepts that we consider relevant for the patient’s individual approach, highlighting the need to obtain a) reliable and reproducible measurements of blood pressure and b) improving the care of people who have blood pressure levels indicating increased cardiovascular risk independently of the classification adopted for blood pressure levels.
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