The SPRINT trial demonstrated cardiovascular benefit from targeting systolic BP <120 mmHg versus <140 mmHg in non-diabetic hypertensives with high CV risk. Which group was explicitly EXCLUDED from the SPRINT trial, limiting applicability of its results?

• A Patients with CKD (eGFR 20–60 mL/min/1.73 m²)
• B Elderly patients >75 years
• C Patients with diabetes mellitus and prior stroke ✓
• D Patients with heart failure with preserved ejection fraction

Explanation

The SPRINT trial excluded patients with diabetes mellitus (who were enrolled in the parallel ACCORD-BP trial, which used auscultatory BP measurement) and patients with prior stroke. Patients with CKD and elderly patients ≥75 years were included (and the elderly subgroup showed particular benefit — SPRINT Senior). The SPRINT intensive target of <120 mmHg reduced the primary composite endpoint (MI, ACS, stroke, HF death, CV death) by 25% and all-cause mortality by 27%. However, SPRINT used an unattended automated oscillometric BP measurement method, which systematically reads approximately 5–10 mmHg lower than clinic readings.

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

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