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Rangga Patria Lazuardi

H2A011036
Hypertension is highly prevalent in the adult
population in the United States, especially among
persons older than 60 years of age, and affects
approximately 1 billion adults worldwide. Among
persons 50 years of age or older, systolic hypertension
is the most common form of hypertension.

Systolic blood pressure becomes more important than


diastolic blood pressure as an independent risk
predictor for coronary events, stroke, heart failure, and
end-stage renal disease (ESRD).
METHODS
SPRINT was a randomized, controlled, open-label trial
that was conducted at 102 clinical sites (organized into
5 clinical center networks) in the United States,
including Puerto Rico.

Participants were required to meet all the following


criteria: an age of at least 50 years, a systolic blood
pressure of 130 to 180 mm Hg and an increased risk of
cardiovascular events.
Eligible participants were assigned to a systolic blood-
pressure target of either less than 140 mm Hg (the
standard-treatment group) or less than 120 mm Hg
(the intensive-treatment group).

Class of anti-hypertension: Thiazide-type diuretics


(encouraged as the first-line agent), loop diuretics (for
participants with advanced chronic kidney disease),
and beta-adrenergic blockers (for those with coronary
artery disease).

Chlorthalidone was encouraged as the primary


thiazide-type diuretic, and amlodipine as the preferred
calcium channel blocker.
Participants were seen monthly for the first 3 months
and every 3 months thereafter.

Medications for participants in the intensive-


treatment group were adjusted on a monthly basis to
target a systolic blood pressure of less than 120 mm
Hg.

Medications for standard-treatment group were


adjusted to target a systolic blood pressure of 135 to 139
mm Hg, and the dose was reduced if systolic blood
pressure was less than 130 mm Hg on a single visit or
less than 135 mm Hg on two consecutive visits.
RESULTS
At 1 year, the mean systolic blood pressure was 121.4
mm Hg in the intensive-treatment group and 136.2
mm Hg in the standard-treatment group, for an
average difference of 14.8 mm Hg. The mean diastolic
blood pressure at 1 year was 68.7 mm Hg in the
intensive-treatment group and 76.3 mm Hg in the
standard-treatment 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.
Serious adverse events occurred in 1793 participants in
the intensive-treatment group (38.3%) and in 1736
participants in the standard-treatment group (37.1%).

A total of 220 participants in the intensive-treatment


group (4.7%) and 118 participants in the standard
treatment group (2.5%) had serious adverse events
that were classified as possibly or definitely related to
the intervention.
CONCLUSIONS
In conclusion, targeting a systolic blood pressure of
less than 120 mm Hg, as compared with less than 140
mm Hg, in patients at high risk for cardiovascular
events but without diabetes resulted in lower rates of
fatal and nonfatal major cardiovascular events and
death from any cause. However, some adverse events
occurred significantly more frequently with the lower
target.
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