BP target 120 more benefit than 140 in high risk cvd patients - but some issues

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Goodfellow Gems

"BP target 120 more benefit than 140 in high risk cvd patients - but some issues"

The results of the SPRINT trial have shown that aiming for a target of 120 mm Hg had more benefits than 140 mm Hg in CVD outcomes.1 The actual blood pressures were 121 vs 136 mmHg at the end of the trial. The outcomes were reduced CVD events 5.2% vs 6.8%, numbers need to treat (NNT) =  61 and for death 3.3% vs 4.5% NNT= 90. The participants had a high CVD risk (20% risk of an event in 10 years) but were excluded if they had diabetes.  The downside was 3 medications were needed in the intervention group versus 2 in the control group. There were more adverse events: hypotension 3.4% vs 2%, syncope 3.5% vs 2.4%, electrolyte disturbance 3.8% vs 2.8% and acute kidney injury/failure 4.4% vs 2.6% but no difference with injurious falls (about 2.2% in both groups). The study authors encouraged the use of chlorthalidone as the preferred diuretic over the commonly used hydrochlorothiazide (in the USA).

References:

  1. http://www.nejm.org/doi/full/10.1056/NEJMoa1511939

Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.


As published in NZ Doctor 3/02/2016