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A Randomized Trial of Intensive versus Standard Blood-Pressure Control

2016; Massachusetts Medical Society; Volume: 374; Issue: 23 Linguagem: Inglês

10.1056/nejmc1602668

1533-4406

Marcel H.A. Muskiet, Lennart Tonneijck, Mark M. Smits,

Cardiovascular Syncope and Autonomic Disorders

A Randomized Trial of Intensive versus Standard Blood-Pressure ControlTo the Editor: Wright et al. (Nov.26 issue) 1 report on the Systolic Blood Pressure Intervention Trial (SPRINT).By focusing on blood-pressure levels, rather than on specific antihypertensive agents, this trial follows a rich heritage of government-funded, noncommercial, randomized trials in hypertension that address major public health issues.The clear differences in outcomes, including lower rates of death among patients who were randomly assigned to intensive treatment than among those assigned to standard treatment, underscore the major impact of implementing this lower blood-pressure target for the appropriate population.Achievement of a difference of 15 mm Hg between patients who were randomly assigned to the intensive-treatment group (target systolic blood pressure <120 mm Hg) and patients who were randomly assigned to the standard-treatment group (target <140 mm Hg) was central to testing the authors' hypothesis.Their design article specifies that in the standard-treatment group, antihypertensive therapy should be withdrawn in a patient whose systolic blood pressure is less than 130 mm Hg on any occasion or less than 135 mm Hg on two consecutive visits. 2 Since withdrawal of antihypertensive therapy in asymptomatic patients in whom these pressures are achieved is not necessarily considered to be standard, interpretation of the overall trial results could be affected by knowledge of how often, and in how many patients, this nonstandard action was taken.