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A Tale of 3 Trials: ACCORD, SPRINT, and SPS3. What Happened?

Lawrence R Krakoff1

  • 1Department of Medicine/Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Lawrence.krakoff@mountsinai.org.

American Journal of Hypertension
|July 1, 2016
PubMed

Insights

Lowering blood pressure goals in hypertension treatment may prevent cardiovascular disease. A meta-analysis suggests a systolic pressure of 125-135 mm Hg is optimal for most patients.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Hypertension Research

Background:

  • The National Institutes of Health funded three major randomized clinical trials (ACORD, SPRINT, SPS3) to evaluate lower blood pressure targets for cardiovascular disease and stroke prevention.
  • These trials collectively involved 17,114 participants and aimed to determine if reduced systolic blood pressure goals offer greater benefits.

Purpose of the Study:

  • To assess the efficacy of intensive blood pressure lowering treatment versus standard treatment in preventing cardiovascular events.
  • To compare the outcomes of three distinct randomized clinical trials with varying inclusion criteria and target blood pressures.

Main Methods:

  • Three large-scale randomized clinical trials (ACORD, SPRINT, SPS3) were conducted.
  • Participants were assigned to either intensive blood pressure treatment (lower goal) or standard treatment.
  • Primary outcomes related to cardiovascular disease and stroke prevention were analyzed.

Main Results:

  • The SPRINT trial demonstrated a significant reduction in primary outcomes with intensive treatment.
  • The ACCORD and SPS3 trials did not show statistically significant benefits for their primary outcomes.
  • Subgroup analyses revealed both similarities and differences across the trials.

Conclusions:

  • When considered collectively with observational studies, these trials suggest an optimal systolic blood pressure range of 125-135 mm Hg for most hypertensive patients on treatment.
  • Intensive blood pressure management may offer significant benefits for specific patient populations, as indicated by the SPRINT trial results.

Keywords:
blood pressureclinical trialsdiabeteshypertensionintensive treatmentlow goalsoutcomesstroke.

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