SPRINT What Remains Unanswered? Where Do We Go From Here? Embargoed Until 2 p.m. ET, Monday, Nov. 9, 2015.

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Presentation transcript:

SPRINT What Remains Unanswered? Where Do We Go From Here? Embargoed Until 2 p.m. ET, Monday, Nov. 9, 2015

SPRINT How generalizable are the results?

SPRINT

How generalizable are the results? How is the J Curve relationship impacted by: Elevated Blood Pressure? Age? Cardiovascular and Cerebrovascular Disease? Chronic Kidney Disease? Diabetes Mellitus?

SPRINT Unanswered questions in need of further studies: What is the optimal SBP goal for patients with DM? Did ACCORD answer this?

SPRINT If the ACCORD results and interpretation are correct… Is the difference in SPRINT and ACCORD results due to the impact of DM on vasculature?

SPRINT Diabetes impact on vasculature? Is DM negatively impacting arteriolar autoregulation in the renal vasculature? Is this shifting the J curve relationship in patients with DM and HTN?

SPRINT

Why different outcomes in SPRINT and ACCORD?

SPRINT Why different outcomes in SPRINT and ACCORD? Was ACCORD underpowered? Young population Lower risk because of lipid arm Excluded patients with Cr > 1.5

SPRINT Why different outcomes in SPRINT and ACCORD? Was ACCORD underpowered? Young population Lower risk because of lipid arm Excluded patients with Cr > 1.5 Difference in diuretic use? ACCORD often used HCTZ SPRINT primarily used Chlorthalidone

SPRINT Why different outcomes in SPRINT and ACCORD? Was ACCORD underpowered? Young population Lower risk because of lipid arm Excluded patients with Cr > 1.5 Difference in diuretic use? ACCORD often used HCTZ SPRINT primarily used Chlorthalidone Trial Design Complex for ACCORD

SPRINT Important related questions for diabetes mellitus: Should another trial in DM be done assuring adequate power? What SBP goal should the new ACC/AHA guidelines recommend for diabetics? Should this be 140, 135, 130, or 120? Recommendation will be based on expert opinion Adverse events in ACCORD were few

SPRINT Unanswered questions in need of further trials: Heart failure with low ejection fraction Heart failure with preserved ejection fraction Drug therapy for untreated SBP ? No benefit in previous trials in patients at this risk level? Or were there power issues with these trials as well?

SPRINT Unanswered questions in HTN unrelated to goal SBP: Will we discover meaningful ways to prevent and treat obesity? Will precision medicine offer opportunities to refine optimal BP management? Goal SBP for individuals More narrowly defined groups

SPRINT Where do we go from here? Consider SPRINT results in new ACC/AHA Blood Pressure Management Guidelines Goal SBP for various groups including DM and lower risk patients including < 50 Management of SBP Consider Global CV Risk? Classification of blood pressure?

SPRINT Where do we go from here? Continue and increase efforts in hypertension research basic science translational science clinical trials population science BP measurement research BP components research Test lower goals in younger patients

SPRINT Where do we go from here? Continue and increase efforts in related research Obesity Precision medicine Continue efforts to better implement what we know lifestyle approaches focus on early prevention improvement of the environment

SPRINT Where do we go from here? Pause momentarily to appreciate the progress in the field of hypertension including the positive results of SPRINT

SPRINT Acknowledgements John Hall Marion Wofford Lyssa Weatherly Bill Cushman Paul Whelton

SPRINT THANK YOU