Intensive systolic BP lowering (<120 mm Hg) in SPRINT adults ≥65 generally produced a net benefit, though the size varied by risk profile and preferences. Using models that combined risks of death, cardiovascular and cognitive outcomes with harms such as acute kidney injury and syncope, researchers estimated individualised net benefit. When benefits were weighted much more heavily than harms, the median net benefit was 4%, and all participants benefited. With equal weighting, the median benefit fell to 1%, but 85% still benefited.
Older (≥75), frail, and polypharmacy patients experienced more harms yet still showed greater net benefit under most simulations.
As clinicians, we are always balancing risk with benefit, and nearly all community-dwelling older adults in SPRINT were predicted to benefit from an intensive BP target. This requires discussion of individual risk and patient value preferences.
As published in NZ Doctor and Research Review
