Heart Failure Primary Prevention: What Does SPRINT Add?: Recent Advances in Hypertension.

Area of Science:

• Cardiology
• Nephrology
• Hypertension Research

Background:

• Hypertension is a primary modifiable risk factor for heart failure development.
• Optimal blood pressure targets for heart failure prevention remain unclear.
• The Systolic BP Intervention Trial (SPRINT) investigated intensive BP control.

Purpose of the Study:

• To evaluate the effectiveness of an intensive systolic blood pressure target (<120 mm Hg) versus a standard target (<140 mm Hg) in preventing heart failure.
• To assess the impact of intensive BP control on acute decompensated heart failure (ADHF) events and recurrence.
• To explore the effects of intensive BP treatment on cardiovascular disease events, cardiac structure, and vascular stiffness.

Main Methods:

• A large, randomized open-label trial (SPRINT) involving 9361 participants.
• Comparison of a systolic BP target <120 mm Hg (intensive arm) versus <140 mm Hg (standard arm).
• Analysis of ADHF events, cardiovascular disease events, and ancillary cardiac assessments (SPRINT HEART).

Main Results:

• The intensive BP target significantly reduced ADHF events by 36% compared to the standard target.
• This benefit was consistent across subgroups, including elderly, CKD, and CVD patients.
• Intensive BP treatment attenuated increases in carotid-femoral pulse wave velocity but did not significantly alter left ventricular mass, function, or fibrosis.

Conclusions:

• Achieving a systolic BP target <120 mm Hg is crucial for preventing ADHF in high-risk hypertensive individuals.
• Intensive BP management offers significant cardiovascular protection, particularly in reducing initial ADHF events.
• Optimal BP reduction is a key strategy for managing hypertension and preventing heart failure.