The SPRINT trial demonstrated that intensive SBP target <120 mmHg reduced cardiovascular events and mortality compared to standard <140 mmHg. However, this trial EXCLUDED patients with which conditions (making generalisation of its results limited)?

• A Patients aged >70 years
• B Patients with isolated systolic hypertension only
• C All patients on ACE inhibitors or ARBs
• D Diabetes mellitus, prior stroke, chronic kidney disease with proteinuria >1 g/day, and patients with expected mortality <3 years ✓

Explanation

SPRINT excluded diabetics (who require the ACCORD-BP trial context), patients with prior stroke (PROGRESS trial), significant proteinuria, heart failure, and those with limited life expectancy. Therefore its intensive targets apply to a specific non-diabetic, non-stroke population with moderate cardiovascular risk. The 2023 ACC/AHA guidelines incorporate SPRINT findings but recommend individualised targets. ACCORD-BP showed no additional CV benefit of intensive targets in diabetics, while increasing adverse events (acute kidney injury, syncope, electrolyte disturbances).

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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