In episode 462, James and Mike invite Scott Garrison to talk about some important nuances around guideline recommendations and how low we should lower systolic blood pressure. We look in detail at the SPRINT trial and then come up with a reasonable (in our minds) approach to what thresholds we should use.
U-Shaped Mortality Curves for Systolic BP
1) Clarify Registry
Vidal-Petiot E, Ford I, Greenlaw N, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet. 2016;388(10056):2142-2152.
2) ONTARGET and TRANSCEND Trials
3) Chinese Longitudinal Healthy Longevity Study
4) Blood Pressure Trajectories in the 20 Years Before Death
5) MDRD Trial
Lazarus JM, Bourgoignie JJ, Buckalew VM, et al. Achievement and safety of a low blood pressure goal in chronic renal disease. The Modification of Diet in Renal Disease Study Group. Hypertension. 1997;29(2):641-650
7) ACCORD Trial
7) SPRINT Main Findings
8) SPRINT Ambulatory BP Sub-study
Drawz PE, Pajewski NM, Bates JT, et al. Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study. Hypertension. 2017;69(1):42-50.
9) Concern over SPRINT BP Measurement Technique
Kjeldsen SE, Mancia G. Unobserved automated office blood pressure measurement in the Systolic Blood Pressure Intervention Trial (SPRINT): systolic blood pressure treatment target remains below 140 mmHg. Eur Heart J Cardiovasc Pharmacother. 2016;2(2):79-80.
10) Comparison of Unobserved Automated Office BP and Ambulatory BP
Seidlerova J, Gelzinsky J, Materankova M, Ceral J, Konig P, Filipovsky J. In the aftermath of SPRINT: further comparison of unattended automated office blood pressure measurement and 24-hour blood pressure monitoring. Blood Press. 2018;27(5):256-261.
Kjeldsen SE, Mancia G. Unattended automated office vs. ambulatory blood pressure in people with high cardiovascular risk: implications for understanding the SPRINT results. J Hypertens. 2019;37(1):6-8.
11) Unattended and Attended SPRINT BP Readings Not Different
12) Comparison Between SPRINT BP and Primary Care Office BP