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SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373:2103-16. PMID 26551272

One-paragraph summary

SPRINT randomised 9,361 adults aged ≥50 with systolic pressure ≥130 mm Hg and increased cardiovascular risk, excluding people with diabetes or prior stroke, to a systolic target below 120 mm Hg or below 140 mm Hg. Pressure was measured by unattended automated office device. At one year, mean systolic pressure was 121.4 versus 136.2 mm Hg. The trial was stopped early after a median 3.26 years: the primary composite (myocardial infarction, other acute coronary syndrome, stroke, heart failure, cardiovascular death) occurred at 1.65% versus 2.19% per year (HR 0.75, 95% CI 0.64–0.89) and all-cause mortality at HR 0.73 (0.60–0.90). Serious adverse events of hypotension, syncope, electrolyte abnormality and acute kidney injury or failure were more frequent in the intensive arm, but injurious falls were not. The 2021 final report, with additional adjudicated events and post-trial follow-up, gave 1.77% versus 2.40% per year (HR 0.73, 0.63–0.86) and all-cause mortality 1.06% versus 1.41% per year (HR 0.75, 0.61–0.92) (PMID 34010531).

Key findings

  • A systolic target below 120 mm Hg reduced major cardiovascular events and all-cause mortality in high-risk adults without diabetes or prior stroke.
  • Achieved separation was ~15 mm Hg, requiring on average about one additional drug and an intensive visit schedule (PMID 35766041).
  • Harms were real but specific: hypotension, syncope, electrolyte disturbance, acute kidney injury — not injurious falls.
  • SPRINT MIND found reduced mild cognitive impairment and a non-significant reduction in probable dementia (PMID 30688979), with less white-matter lesion progression (PMID 31408137) — endpoints belonging to vascular-dementia.
  • Prespecified CKD subgroup results were concordant with the whole trial, without a deleterious effect on the main kidney outcome (PMID 28642330).

Limitations

  • Measurement. Unattended automated office readings run lower than routine attended office readings by a heterogeneous amount (PMID 31290085), so the achieved "121.4 mm Hg" is not directly transferable to clinic practice. This is the single most consequential limitation and remains unresolved.
  • Early stopping for benefit inflates effect estimates; the final report's slightly attenuated hazard ratios are consistent with that.
  • Exclusion of diabetes and prior stroke limited generalisability for a decade, until ESPRIT (PMID 38945140) and BPROAD (PMID 39555827) supplied the missing populations.
  • The trial population was at high absolute risk by design; the same relative effect yields much smaller absolute benefit at lower risk.
  • Intensive visit frequency and protocolised titration are part of the intervention and are not usually reproduced in practice.

Why it matters

SPRINT reopened a question most of the field considered settled and moved every subsequent guideline's target downward. It also created the field's central measurement problem: a trial target defined by a method few clinics use. Reading SPRINT correctly requires holding both facts at once — the benefit is real and replicated, and the number cannot be transcribed into a clinic without knowing how the pressure was taken.

Cited by wiki pages

  • overview
  • blood-pressure targets
  • risk and outcomes
  • red flags and safety concerns