Last November the NEJM published the results of SPRINT and showed a dramatic improvement in outcomes with a lower blood pressure target:
The NNT for the trial was impressive:
The numbers needed to treat to prevent a primary outcome event, death from any cause, and death from cardiovascular causes during the median 3.26 years of the trial were 61, 90, and 172, respectively.
But I still have not embraced the results in my practice. My patients are on a lot of medications and I usually already have them on 3 or 4 medications just to get their systolic pressures down to the 130s. This is quite a bit more than the 1.8 drugs per patient that were used at baseline in the SPRINT cohort. TIt is incredible, bordering on unbelievable, that the investigators were able to get their study patients down to an average blood pressure of 121.4 mmHg with only 1 additional drug (2.8 antihypertensives per patient in the intensive control group):
Throughout the 3.26 years of follow-up, the mean systolic blood pressure was 121.5 mm Hg in the intensive-treatment group and 134.6 mm Hg in the standard-treatment group, and the mean number of blood-pressure medications was 2.8 and 1.8, respectively.
My sense is that it would take 5, 6, or even 7 medications to get some of my patients down to the SPRINT target. With that degree of pharmacologic intervention, I fear that side effects would overtake the cardiovascular benefits. Given the recent results from the HOPE-3 trial, my skepticism may have been validated.
