- What does the SPRINT study say about lowering blood pressure?
The clinical trial sponsored by the National Institutes of Health, called the Systolic Blood Pressure Intervention Trial (SPRINT), studied people over age 50 who had high blood pressure and at least one other risk factor for heart disease. (Patients with diabetes, prior stroke or polycystic kidney disease were not included.) The study was stopped early when it found that using medicines to reduce systolic blood pressure to 120 millimeters of mercury (mm Hg) reduced the combined rate of having a heart attack, acute coronary syndrome, heart failure or stroke by nearly one third, and reduced deaths from any cause by nearly a one-quarter compared to reducing blood pressure to less than 140 mm Hg (the current recommended level).
- Why are the findings significant?
Since a report in JAMA last year from a former NHLBI-empanelled writing group (referred to throughout this document as the JAMA writing group) there has been a lot of debate about the appropriate goal level for treating high blood pressure. The JAMA writing group published recommendations suggesting a higher goal level than the current AHA guidelines. This publication was not endorsed by the NHLBI, the AHA or the ACC. And now, the SPRINT study indicates that a lower goal level is actually more beneficial.
- What are the different recommendations compared with the new SPRINT findings?
The JAMA writing group recommended that:
- Healthy adults under the age of 60 should strive for a blood pressure below 140/90.
- Healthy adults over the age of 60 should strive for a blood pressure below 150/90.
Current AHA/ACC recommendations:
- Healthy adults under the age of 80 should strive for a blood pressure below 140/90.
- Healthy adults over the age of 80 should strive for a blood pressure below 150/90.
The SPRINT study indicates:
Healthy adults under the age of 80 should strive for a blood pressure below 140/90.Healthy adults over the age of 80 should strive for a blood pressure below 150/90.
- Adults with high blood pressure over age 50 had lower rates of a composite of heart attack, acute coronary syndrome, heart failure or stroke, and of death from any cause when treated to aim at a systolic blood pressure level less than 120 as compared with those aiming at less than 140.
- Will the AHA update its guidelines based on the SPRINT findings?
The ACC/AHA Taskforce on Practice Guidelines has already begun the evidence review and writing process, in partnership with the NHLBI, to update guidelines for clinicians to follow as the national standard for hypertension prevention and treatment. The SPRINT findings, once published, will be included in that decision-making for the updated guidance.
- With so many different recommendations, what target should patients shoot for?
For specific concerns, patients should consult with their healthcare provider to determine the goal that’s most appropriate.
- Healthy people should have a blood pressure at or below 120/80.
- For people under age 80 who are being treated for high blood pressure, the current guidelines recommend a target below 140/90.
- For people older than 80 who are being treated for high blood pressure, the current guidelines recommend a target below 150/90.
- For people with high blood pressure who also have conditions such as kidney disease or diabetes, the recommended target is below 130/80.
- Why did the writing group originally empanelled by the NHLBI publish its own report on hypertension in JAMA?
Although we recognize the enormous contribution of the NHLBI writing group that conducted a review of scientific evidence on hypertension, we don’t know why they decided to publish their report independently. However, the NHLBI has asked the AHA/ACC Taskforce on Practice Guidelines to manage and issue the national guidelines on hypertension, working collaboratively with a broad group of professional organizations with a focus on hypertension. This will accompany the other four prevention guidelines relevant to cardiovascular disease and stroke that we are continuing to manage collaboratively with the NHLBI.
- Why is the difference between the AHA guidelines and the writing group report important?
Millions of Americans between the age of 60 and 80 could be confused over which blood pressure target to follow. A relaxed target for this age group (aiming only at bringing BP down to <150/90) would create a dangerous false-sense of security and take focus away from hypertension as a significant risk factor for heart disease and stroke.
- Why would there be a discrepancy between the writing group recommendations and the AHA’s current position on blood pressure?
There is a difference in methodology. The AHA relies on a wider breadth of science to develop our guidelines, whereas the JAMA group focused on a rigorous but limited review of the evidence addressing targeted questions.
For more information on blood pressure, visit www.heart.org/bloodpressure