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Heart failure physicians were quick to embrace the sub–120 mm Hg systolic blood pressure target for both patients and at-risk people fewer than 3 weeks after the early-release news came out from the SPRINT trial that treating to this level produced a significant cut in cardiovascular disease events, compared with a less stringent systolic blood-pressure target of below 140 mm Hg.
At the annual meeting of the Heart Failure Society of America this week – one of the first cardiology gatherings held since the SPRINT announcement on Sept. 11 – at least 10 heart failure specialists offered their opinion at various times during the sessions on what the results have already meant for their practice. What was most striking was their unanimity in accepting this new blood pressure treatment target for heart failure patients and for people at increased risk for developing heart failure, and the rapidity at which they had come to their decision despite the absence so far of details about the trial’s results.
The unifying theme was that these physicians constituted a highly receptive audience for the SPRINT message, several of these specialists said in interviews. They appeared poised to pounce on a scientific rationale as soon as it became available to adopt a more aggressive blood pressure goal. It’s certainly no coincidence that most (if not all) these physicians now see uncontrolled hypertension as one of the top drivers of both heart failure onset and progression.
Dr. Margaret M. Redfield
“We’ve all had some misgivings” about the systolic blood pressure targets set by the JNC 8 panel members last year of less than 150 mm Hg or less than 140 mm Hg (depending on age), and as a result of those misgivings, “I think people were ready to do a reverse and accept a new, lower target,” said Dr. Margaret M. Redfield, a heart failure specialist who was among those at the meeting who voiced endorsement for a new, sub–120 mm Hg target. “We don’t have the [SPRINT] data yet, but it’s very unusual for the NHLBI to release trial information ahead of time, so it must be very dramatic,” she added.
“The data and safety monitoring board had strict rules to govern early stopping,” said Dr. Clyde W. Yancy, a heart failure cardiologist and a member of the SPRINT data and safety monitoring panel. While careful not to prematurely provide any unreleased details of the SPRINT results, Dr. Yancy tried to frame what the September announcement meant in objective terms, while also rationalizing the quick uptake of the finding by so many of his colleagues.
Dr. Clyde W. Yancy
“The decision to stop early must have been driven by some high level of evidence,” he told me, “You can infer a significant scientific rational” for a new target of less than 120 mm Hg “and you have to also surmise that there was no signal of harm.”
And, of course, some cardiologists had decided even before the SPRINT results came out in September that a lower target was better even without any evidence to back up that instinct.
“I love the 120s; a 140-mm Hg target has always been too high for me,” said Dr. Ileana L. Piña, a heart failure specialist at Montefiore Medical Center, Bronx, N.Y.
Another question, following so many endorsements of the 120-mm Hg goal, was whether these physicians believed people stood a good chance to reach this ambitious target.
“It’s a target; it’s not that everyone will get to it, but we need to apply the same rigor for blood pressure control as we use in heart failure clinics,” Dr. Redfield said. “We need to use a system” for patient support and monitoring and to promote adherence to treatment, “and keep pushing” patients to work toward their goal, she said.
Dr. Yancy predicted that a more aggressive blood pressure goal will help generate a stronger and more innovative infrastructure of drugs and monitoring tools to help patients get there.
“If a target blood pressure of 120/80 mm Hg gains credibility in guidelines, I think that industry will respond” with more combined drug formulations, new drugs, and innovative methods for easier blood pressure measurement, he said.
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