Final Report of a Trial of Intensive versus Standard Blood-Pressure Control

   This final report of the SPRINT randomized trial presents comprehensive follow-up data comparing intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic blood pressure targets in 9361 patients at elevated cardiovascular risk. After a median 3.33 years of treatment and 3.88 years including post-trial observation, intensive therapy significantly reduced the composite outcome of cardiovascular events (HR 0.73) and all-cause mortality (HR 0.75) compared to standard treatment. However, it also led to increased rates of serious adverse events hypotension, electrolyte abnormalities, acute kidney injury, and syncope. The long-term data show sustained benefit, though heart failure rates equalized post-trial, possibly due to medication changes. Renal outcomes varied: while end-stage events did not differ in chronic kidney disease (CKD) patients, intensive therapy was associated with early eGFR decline among those without baseline CKD. The study supports a lower systolic target for high-risk populations, with careful adverse event monitoring.

   This final report of the SPRINT randomized trial presents comprehensive follow-up data comparing intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic blood pressure targets in 9361 patients at elevated cardiovascular risk. After a median 3.33 years of treatment and 3.88 years including post-trial observation, intensive therapy significantly reduced the composite outcome of cardiovascular events (HR 0.73) and all-cause mortality (HR 0.75) compared to standard treatment. However, it also led to increased rates of serious adverse events hypotension, electrolyte abnormalities, acute kidney injury, and syncope. The long-term data show sustained benefit, though heart failure rates equalized post-trial, possibly due to medication changes. Renal outcomes varied: while end-stage events did not differ in chronic kidney disease (CKD) patients, intensive therapy was associated with early eGFR decline among those without baseline CKD. The study supports a lower systolic target for high-risk populations, with careful adverse event monitoring.