New Data from SPRINT Trial Offer Insights for Hypertension Control

UH Clinical Update | October 2022

New data from the landmark SPRINT trial reveal how patients with hypertension can achieve the recommended systolic blood pressure (SBP) target of 130 or lower, regardless of their age or race or ethnic background.

Why it matters: Previous data from SPRINT has shown that intensively managing SBP to 120 or lower reduces patients’ risk of major cardiovascular disease events by 27 percent and deaths by 25 percent, compared to those treated to the previously recommended target of less than 140. In addition, those levels of blood pressure were achievable and sustainable long-term.  However, until now, details on how this can be achieved haven’t been widely available.

“A SBP target that low had not been attempted in any other previous clinical trial, especially in one looking at clinical outcomes,” says Jackson T Wright, Jr., MD, PhD, Director of the Clinical Hypertension Program at UH Cleveland Medical Center and a senior author on the new SPRINT paper, published in the journal Hypertension.

Choosing Medications

“The choice of medications was critical to the conduct of the study,” Dr. Wright says. “The choice certainly centered on the use of medications that had been shown to be effective in preventing the complications of hypertension. But we also knew that some drug combinations, particularly in the Black population, were less effective.”

The SPRINT Formula for Hypertension Control

Chlorthalidone, a thiazide-like diuretic, was encouraged as the SPRINT-endorsed primary thiazide-type diuretic, Dr. Wright says. Amlodipine was the preferred calcium channel blocker.  These are very long-acting medications as well as effective in lowering blood pressure in nearly all patient groups

These are not the usual choices for many physicians, Dr. Wright says.

“For instance, most providers were using hydrochlorothiazide and in doses well below those proven effective in clinical outcome trials,” he says. “It is still the diuretic of choice for most providers within the U.S. and in many of the quality improvement programs. However, what has been found among patients in those quality improvement programs, Black patients do not achieve the same level of blood pressure control with low-dose hydrochlorothiazide as did non-Black patients.”

Under the SPRINT protocol, this gap has all but disappeared.

“The regimen that was used in SPRINT was not only effective in achieving the blood pressure targets, but it was also effective in essentially eliminating the Black-white blood pressure control gap seen in other studies,” Dr. Wright says. “The bottom line is that we were able achieve the SPRINT blood pressure targets, even those less than 120 SBP in nearly all the subgroups – patients regardless of age, race/ethnicity, frailty status, presence of kidney disease and more.”

Encouraging Results

The new data from SPRINT show that at their final visit, more than 62 percent of patients in the intensive therapy arm of the trial had their SBP controlled to below 120, and 71 percent of patients in the standard therapy had their SBP controlled below 140. However, more than 90 percent of patients in the intensive arm achieved a SBP less than the previously recommended target of 140, and 80 percent achieved the target of less than 130 – recommended by current guidelines.

A Call to Action

Dr. Wright says he hopes these new data will help providers and their patients achieve the SBP goals established in the SPRINT trial.

“It’s a work in progress,” he says. “Currently, only about one-third of patients have SBP controlled at less than 130 – the target of both U.S. and international guidelines. Chlorthalidone is grossly under-utilized. Even in patients whose blood pressure is uncontrolled to recommended levels, less than 10 percent of patients, in fact, are being treated with it, and less 30 percent are receiving full doses of amlodipine. There is a lot more we can to do improve blood pressure control.”

One other intervention from the SPRINT trial worth bringing into clinical practice, according to Dr. Wright: monthly monitoring until the patient achieves the prescribed SBP goal.

“Certainly bringing those patients in, initially monthly until the blood pressure is controlled, is critical,” he says.  “If we can achieve a SBP target of less than 120 in SPRINT, the ability to achieve a SBP of less than 130 is clearly doable for the patients we see in our practices.”