Researchers have long debated the optimal blood pressure for people more than 50 years old, especially in older adults who might not tolerate lower blood pressure. Alfred Cheung, MD, and colleagues at University of Utah Health led one of five national Clinical Center Networks to design and conduct the Systolic Blood Pressure Intervention Trial (SPRINT). They examined whether targeting a systolic blood pressure below 120 mm Hg would improve health outcomes compared to targeting systolic blood pressure below 140 mm Hg, previously considered the standard target.
Cheung and colleagues found that intensive blood pressure lowering led to a 25% decrease in major cardiovascular events and all-cause mortality. Adam Bress, PharmD and colleagues determined that the intervention was also economically cost-effective. The cardiovascular and survival benefits extended to people over 75 years old and to individuals with underlying kidney disease or prediabetes, without significant side effects. Additional analyses showed that intensive blood pressure lowering also decreased the combined rate of mild cognitive impairment, including in older adults. This landmark study led to new clinical practice guidelines and changed perceptions of the risk/benefit ratio of intensive blood pressure control in older adults.
A randomized trial of intensive versus standard blood-pressure control. SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT. N Engl J Med. 2015 Nov;373(22):2103-2116.
Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, Fine LJ, Haley WE, Hawfield AT, Ix JH, et al., SPRINT Research Group. JAMA. 2016 Jun;315(24):2673-2682.
Effect of intensive versus standard blood pressure treatment according to baseline prediabetes status: a post hoc analysis of a randomized trial. Bress AP, King JB, Kreider KE, Beddhu S, Simmons DL, Cheung AK, Zhang Y, Doumas M, Nord J, Sweeney ME, et al., SPRINT Research Group. Diabetes Care. 2017 Aug;40(10):1401–1408.
Effects of intensive BP control in CKD. Cheung AK, Rahman M, Reboussin DM, Craven TE, Greene T, Kimmel PL, Cushman WC, Hawfield AT, Johnson KC, et al., SPRINT Research Group. J Am Soc Nephrol. 2017 Sep;28(9):2812-2823.
Effects of intensive systolic blood pressure control on kidney and cardiovascular outcomes in persons without kidney disease: a secondary analysis of a randomized trial. Beddhu S, Rocco MV, Toto R, Craven TE, Greene T, Bhatt U, Cheung AK, Cohen D, Freedman BI, Hawfield AT, et al., SPRINT Research Group. Ann Intern Med. 2017 Sep;167(6):375-383.
Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. SPRINT MIND Investigators for the SPRINT Research Group, Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G, Cheung AK, Cleveland ML, Coker LH, Crowe MG, et al., JAMA. 2019 Feb;321(6):553-561.
Intensive vs standard blood pressure control in adults 80 years or older: a secondary analysis of the Systolic Blood Pressure Intervention Trial. Pajewski NM, Berlowitz DR, Bress AP, Callahan KE, Cheung AK, Fine LJ, Gaussoin SA, Johnson KC, King J, Kitzman DW, et al., J Am Geriatr Soc. 2019 Mar;68(3):496-504.
Association of intensive vs standard blood pressure control with cerebral white matter lesions. SPRINT MIND Investigators for the SPRINT Research Group, Nasrallah IM, Pajewski NM, Auchus AP, Chelune G, Cheung AK, Cleveland ML, Coker LH, Crowe MG, Cushman WC, Cutler JA, et al., JAMA. 2019 Aug;322(6):524-534.
Final Report of a Trial of Intensive versus Standard Blood-Pressure Control. SPRINT Research Group, Lewis CE, Fine LJ, Beddhu S, Cheung AK, Cushman WC, Cutler JA, Evans GW, Johnson KC, Kitzman DW, et al., N Engl J Med. 2021 May 20;384(20):1921-1930.