A Randomized Trial of Intensive versus Standard Blood-Pressure Control (SPRINT)

The SPRINT trial randomized 9,361 hypertensive adults without diabetes (age ≥50 years, SBP 130–180 mmHg) to intensive blood pressure control (target SBP <120 mmHg) versus standard control (target SBP <140 mmHg) across 102 US clinical sites. The primary outcome was the composite of cardiovascular events and cardiovascular death. The trial was stopped early at a median follow-up of 3.26 years for significant benefit.

Intensive blood pressure control reduced the primary composite cardiovascular outcome by 25% (HR 0.75, 95% CI 0.64–0.89) and all-cause mortality by 27% (HR 0.73, 95% CI 0.60–0.90) compared with standard control. Achieved SBP was 121.4 vs 136.2 mmHg in the two groups. Serious adverse events — particularly hypotension, syncope, electrolyte abnormalities, and acute kidney injury — were more common with intensive treatment, though most were transient and manageable.

SPRINT established that hypertension treatment targets below the previous standard of <140 mmHg produce significant cardiovascular benefit in a high-risk non-diabetic population. The NNT for the primary composite endpoint was approximately 61 over 3.26 years — a clinically meaningful effect size. The diabetic exclusion means SPRINT’s targets do not directly apply to diabetic hypertensives, for whom the ACCORD trial provides guidance.

The trial’s stopping-for-benefit slightly inflates the observed effect size, but the magnitude of cardiovascular and mortality benefit across multiple endpoints is robust. Intensive BP control is now standard-of-care for appropriate patients, with SBP targets of <130 mmHg reflected in major guidelines.

We rate the evidence strong. The landmark SPRINT trial establishing that intensive blood pressure control (target <120 mmHg) reduces cardiovascular events and all-cause mortality by approximately 25% and 27% respectively in high-risk non-diabetic hypertensives — a foundational result in hypertension management.