In the Wake of Systolic Blood Pressure Intervention Trial: New Targets for Improving Hypertension Management in Chronic Kidney Disease?

Impact of the SPRINT Trial on Hypertension Management

The Systolic Blood Pressure Intervention Trial is the first large prospective randomized controlled trial to demonstrate the benefit of an intensive systolic blood pressure (SBP) treatment target (<120 mm Hg) compared to a standard target (<140 mm Hg) in reducing cardiovascular morbidity and mortality and all-cause mortality in high-risk hypertensive patients. The impact of SPRINT on hypertension treatment has been large, but major questions remain about the feasibility of achieving the SPRINT intensive SBP target in routine practice, the generalizability of the SPRINT findings to hypertensive populations that were excluded from the trial, and the cost effectiveness of adopting the SPRINT intensive treatment goal. In this review, we discuss the generalizability of SPRINT data to the general population of adults with hypertension and with various comorbidities, the cost effectiveness of intensive SBP-lowering therapy, and the implications of SPRINT for future hypertension guideline development and clinical practice.

Sex Differences in Regulation of Blood Pressure

Hypertension is one of the leading risk factors for cardiovascular disease, myocardial infarction, and stroke. There are gender differences in the prevalence of hypertension and in the mechanisms responsible for hypertension in humans. This review will discuss the mechanisms for regulation of blood pressure, sex differences that have been identified in animal studies, and the gender differences that have been identified in humans.