The SPRINT Research Group
A Randomized Trial of Intensive versus
Standard Blood-Pressure Control
[Texte complet / nejm.org]
L'étude SPRINT montre donc que, dans une population d'hypertendus à risque cardiovasculaire élevé (mais indemnes de diabète), avoir pour cible une PAS inférieure à 120 mm Hg comparée à une PAS cible inférieure 140 mm Hg, s'accompagne d'un taux plus faible d'événements cardiovasculaires mortels ou majeus et de décès de toutes causes, au prix d'un taux significativement plus élevé de certains effets secondaires.
The most appropriate targets for systolic blood pressure to reduce cardiovascular
morbidity and mortality among persons without diabetes remain uncertain.
We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg
or higher and an increased cardiovascular risk, but without diabetes, to a systolic
blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of
less than 140 mm Hg (standard treatment). The primary composite outcome was
myocardial infarction, other acute coronary syndromes, stroke, heart failure, or
death from cardiovascular causes.
At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensivetreatment
group and 136.2 mm Hg in the standard-treatment group. The intervention
was stopped early after a median follow-up of 3.26 years owing to a significantly
lower rate of the primary composite outcome in the intensive-treatment
group than in the standard-treatment group (1.65% per year vs. 2.19% per year;
hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to
0.89; P<0.001). All-cause mortality was also significantly lower in the intensivetreatment
group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003). Rates of serious
adverse events of hypotension, syncope, electrolyte abnormalities, and acute
kidney injury or failure, but not of injurious falls, were higher in the intensive-treatment
group than in the standard-treatment group.
Among patients at high risk for cardiovascular events but without diabetes, targeting
a systolic blood pressure of less than 120 mm Hg, as compared with less than
140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular
events and death from any cause, although significantly higher rates of some adverse
events were observed in the intensive-treatment group.
(Funded by the National
Institutes of Health; ClinicalTrials.gov number, NCT01206062.)