SPRINT and BP targets of anthypertensive treatment
The results of the Systolic Blood Pressure Intervention Trial (SPRINT) have been recently published (New England Journal of Medicine, November 9, 2015). This was a large trial including 9361 participants with Systolic Blood Pressure (SBP) ≥130 mmHg and high cardiovascular risk but no diabetes or previous stroke. They were treated to a SBP target <120 mmHg (intensive treatment) or to a target <140 mmHg (standard treatment).
The trial was stopped early because a 25% lower relative risk of major cardiovascular events (mostly less CHF) and a 27% lower relative risk of death from any cause were observed in participants assigned to the intensive-treatment group.
In the same intensive-treatment group significantly higher rates of some adverse events were observed (i.e. syncope, electrolyte abnormalities and acute kidney injury or failure).
Although these results will probably have a major influence on the treatment of hypertensive patients, they should be largely discussed before being safely and effectively applied in clinical practice. The discussion should be focused on the detection of subgroups of patients who most likely could benefit of intensive treatment. How much the results can be extended to the large population of patients not represented in the trial (i.e. diabetics, previous stroke, CVD risk <15%, SBP >180 or <130 mmHg, patients aged <50 yrs) will also require appropriate expert debate. Additional issues will deserve further evaluation, including 1) the method to be used for BP measurement in order to classify patients for initiating and continuing treatment, 2) how to asses and treat the frail elderly patients, 3) the cost for management of patients in order to obtain long-term reduction of SBP below 120 mmHg.
The results of SPRINT are likely to have a major impact on how doctors will treat their hypertensive patients and on the indications given by Guidelines committees.
The European Society of Hypertension will widely discuss the results and has programmed a careful reevaluation of target of anthypertensive treatment, based on the evidence from SPRINT and other large randomized clinical trials as well as on other sources of data, not excluding an appropriate and focused clinical judgement.
Enrico Agabiti Rosei
From the ESH President
It is with great pleasure and honour that I begin my two-year term as President of the European Society of Hypertension (2015-2017).
Scientific research in hypertension has produced results that have permitted rapid and effective progress in the diagnostic and therapeutic approach to this multifaceted disease, representing one of the greatest successes of modern medicine. However, hypertension continues to afflict a large portion of the general population and remains the most important cause of fatal events worldwide, representing a very large health, social and economic problem.
Experimental and clinical research in hypertension has lead to the discovery of new pathophysiological pathways and new therapeutic strategies that have also been transferred to the management of other cardiovascular, cerebrovascular and renal diseases. However, we need to optimize and utilize this large body of knowledge in everyday clinical practice. Therefore, the very successful scientific approach to hypertension must continue and must be strenghtened, in particular by facilitating the access of young investigators to research work. In addition, we must take advantage of the continuous progress and improvement in technology, to encourage communication and integration within the Society, and to improve the diagnostic and therapeutic processes to achieve excellent clinical practice.
In summary, our activities should aim at better IMPLEMENTATION of what has been already demonstrated as useful and effective; at constant, excellent basic and clinical INVESTIGATION and research that may lead to new important discoveries; at careful, but strong INNOVATION in communication, clinical work and research activities. The main goals of our Society for the next few years are: 1) to optimize control of BP in the general population, 2) to organize regular and structured educational activities, extended also to extraeuropean countries, in conjunction with the very successful Affiliation/Association Program of the ESH, 3) to create a strong network for scientific research.
All this can be obtained only by strengthening the collaboration and joint efforts of the National Societies, the ESH Excellence Centres and the ESH Hypertension Specialists that represent the backbone of our Society, thanks to the efforts of the past Presidents and Members of the Scientific Council.
I am truly confident that all the members of the European Society of Hypertension will give their dedicated and enthusiastic contribution.
Enrico Agabiti Rosei
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Interview with E. Agabiti Rosei at ESH 2015 Annual Meeting: