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SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373:2103–2116. PMID 26551272

One-paragraph summary

SPRINT randomized 9,361 adults with systolic BP at least 130 mm Hg and elevated cardiovascular risk, but without diabetes or prior stroke, to systolic targets below 120 or 140 mm Hg. At one year, mean systolic BP was 121.4 versus 136.2 mm Hg. Intensive treatment reduced the primary cardiovascular composite, HR 0.75 (95% CI 0.64–0.89), and all-cause mortality, HR 0.73 (0.60–0.90), prompting early termination. Serious adverse events overall did not differ, but hypotension, syncope, electrolyte abnormalities, and acute kidney injury/failure were more frequent.

Design

Element Detail
Population 9,361 adults, age ≥50, elevated cardiovascular risk
Major exclusions Diabetes, prior stroke, symptomatic HF, EF <35%
Intervention Systolic target <120 mm Hg
Comparator Systolic target <140 mm Hg
Measurement Standardized automated office BP protocol
Primary outcome MI, other ACS, stroke, HF, or cardiovascular death

Key findings

  • Primary outcome: 1.65% versus 2.19% per year; HR 0.75 (95% CI 0.64–0.89).
  • All-cause mortality: HR 0.73 (95% CI 0.60–0.90).
  • The 2021 final report confirmed primary-outcome HR 0.73 (0.63–0.86) and mortality HR 0.75 (0.61–0.92) (PMID 34010531).
  • Intensive assignment reduced ECG-LVH development/regression endpoints in ancillary analyses.
  • Treatment required more medicines and structured follow-up than routine care.

Limitations

  • The measurement protocol complicates direct translation to casual routine-office readings.
  • Diabetes and prior stroke were excluded; ACCORD BP and stroke-specific evidence must be considered separately.
  • The trial was not restricted to imaging-defined HHD and did not test a remodeling-guided strategy.
  • Early stopping can enlarge apparent treatment effects.
  • Renal and symptomatic harms make tolerability an outcome, not a footnote.

Why it matters

SPRINT establishes that a lower pressure target can prevent clinical events in selected high-risk adults. For HHD it is prevention evidence, not proof that every patient with LVH should be driven below a single number. Measurement fidelity, orthostatic symptoms, kidney function, frailty, and patient priorities remain essential.

Cited by wiki pages

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