“The main differences were that the ACCORD trial had less statistical power than SPRINT, and its primary outcome included a higher proportion of events that are less sensitive to blood-pressure reduction,” wrote Drs Perkovic and Rodgers.

After looking at the analysis, Dr Bakris agreed that there is equipoise between the 2 studies. “If you take all the end points together, there is a benefit seen in ACCORD,” he said.


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Impact on Guidelines

One of the changes Dr Bakris expects as a result of the SPRINT findings is with current clinical guidelines.

“The international kidney guidelines — Kidney Disease: Improving Global Outcomes — are going to be modified, but not by much,” he noted. “The general [hypertension] guidelines from the American Heart Association and American College of Cardiology (the group that replaced the Joint National Committee) are definitely going to change.”

While the exact modifications have yet to be determined, Dr Bakris explained that a range for blood pressure would be a more reasonable target than a specific number.

“You don’t need to be below 125 [mm Hg] and you really shouldn’t be above 130 [mm Hg], and that sits beautifully with the SPRINT data because that is where things were. Some of the SPRINT senior investigators and I have talked, and they agree with this notion of a range,” he said.

“This is not physics; it’s biology,” Dr Bakris continued. “There is variability much greater than what you would expect and there was variability in the trial, so it is unreasonable to pick a number and go from that. It’s a guidepost.”

The new hypertension guidelines are slated for publication in 2016.6

Crossing the Finish Line

For Dr Gerstein, the data from SPRINT will help inform how he treats patients going forward, but what remains foremost in his patient care is treating patients as individuals.

“You have to individualize your care for the patient by doing a good history and physical examination, the right blood test, and deciding what their risks are for having an event,” he said. “With SPRINT, we now have another piece of evidence to incorporate into our decision-making. However, the evidence shouldn’t dictate how we manage patients, but rather it should inform how we manage them.”

Disclosures: Drs Bakris and Gerstein report no relevant financial disclosures.

References

  1. Drazen JM, Morrissey S, Campion EW, Jarcho JA. A SPRINT to the finish. N Engl J Med. 2015;373:2174-2175. doi:10.1056/NEJMe1513991.
  2. Landmark NIH study shows intensive blood pressure management may save lives [news release]. Bethesda, MD: National Heart, Lung, and Blood Institute; September 11, 2015. https://www.nhlbi.nih.gov/news/press-releases/2015/landmark-nih-study-shows-intensive-blood-pressure-management-may-save-lives. Accessed December 21, 2015.
  3. The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure Control. N Engl J Med. 2015;373:2103-2116. doi:10.1056/NEJMoa1511939.
  4. The ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575-1585. doi:10.1056/NEJMoa1001286.
  5. Perkovic V, Rodgers A. Redefining blood-pressure targets — SPRINT starts the marathon. N Engl J Med. 2015;373:2175-2178. doi:10.1056/NEJMe1513301.
  6. Hypertension guideline writing process underway [news release]. Dallas, TX: American Heart Association; February 17, 2015. http://newsroom.heart.org/news/hypertension-guideline-writing-process-underway. Accessed December 22, 2015.