The SPRINT trial changed hypertension management targets. What was the key finding and what is the current controversy regarding intensive BP targets?

• A Intensive target SBP <120 mmHg reduced stroke in diabetic patients specifically
• B Intensive target SBP <120 mmHg reduced cardiovascular events but increased AKI and hypotension risk; applies to non-diabetic high-risk patients ✓
• C SPRINT showed SBP target of 140–150 mmHg is optimal for all patients over 60
• D SPRINT found no benefit of intensive BP control in patients with CKD

Explanation

The SPRINT trial (2015) randomised non-diabetic high-risk hypertensive patients to intensive SBP target (<120 mmHg) vs. standard (<140 mmHg) and found significant reduction in cardiovascular events and all-cause mortality in the intensive group. However, intensive treatment increased AKI (acute kidney injury), syncope, and electrolyte abnormalities. Diabetic patients were excluded (ACCORD trial addressed diabetics, showing no CV benefit). The controversy persists regarding whether automated BP measurement in SPRINT overstates real-world benefit. Current ACC/AHA guidelines recommend SBP <130 mmHg for high-risk patients based partly on SPRINT.

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

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