Blood Pressure Control After SPRINT—Back to Reality

In this issue of JAMA Cardiology, Jaeger and colleagues1 report a secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) study evaluating the association of long-term intensive blood pressure (BP) treatment with cardiovascular and all-cause mortality. Sadly, the robust reduction in mortality seen in the intensive treatment group during the intervention period was not evident 4.5 years after the trial ended. In a subanalysis of nearly 3000 participants, outpatient systolic BP was examined using electronic health records to evaluate long-term management of hypertension after SPRINT. After the trial ended, mean outpatient systolic BP increased from approximately 133 to 140 mm Hg among participants in the intensive treatment group—similar levels as the standard treatment group. Taken together, these findings underscore the importance of maintaining BP reduction over the long term and demonstrate the challenge of achieving sustained intensive BP reduction in a real-world setting.