Cardiovascular Atlas
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Intensive systolic blood-pressure lowering (target below 120 mm Hg)

A treatment plan that adjusts blood-pressure medicines until the top number is under 120, rather than the more usual under 140.

  • Intervention
  • In this atlas

Overview

Technical summary

Treat-to-target antihypertensive strategy with a systolic goal below 120 mm Hg, as tested in SPRINT. It is a strategy, not a specific drug.

About this intervention

Type
Medicine
Mechanism
Not reported

Claims and evidence

Context Adults 50 and over with raised systolic blood pressure and increased cardiovascular risk, without diabetes or prior stroke (SPRINT)

Recipient
Adult
Population
Adults aged 50 years or older with systolic blood pressure of 130 to 180 mm Hg (the registry lowers the upper limit as the number of blood-pressure medicines rises) and at least one increased-risk criterion, excluding diabetes mellitus and prior stroke.
Care setting
Outpatient trial clinics at 102 clinical sites. Nursing-home and assisted-living residents were not enrolled.
Geography
United States, including Puerto Rico
Life stage
Adult, 50 years and over (28.2% of each arm aged 75 or over, per Table 1 of the paper)
Follow-up
Median follow-up 3.26 years when the blood-pressure intervention was stopped early on 2015-08-20. The registry gives a planned maximum follow-up of 6 years. Mean systolic pressure at 1 year was 121.4 mm Hg (intensive) and 136.2 mm Hg (standard).
Eligibility: 6 inclusion criteria; 8 exclusion criteria
Included
  • Age 50 years or older
  • Systolic blood pressure 130 to 180 mm Hg (paper). Registry upper limits by number of blood-pressure medicines: 0 to 1 medicines 130 to 180, up to 2 medicines 130 to 170, up to 3 medicines 130 to 160, up to 4 medicines 130 to 150.
  • At least one increased cardiovascular risk criterion: clinical or subclinical cardiovascular disease other than stroke; chronic kidney disease (excluding polycystic kidney disease); Framingham 10-year cardiovascular risk of 15% or greater; or older age.
  • Kidney criterion, worded differently by the sources and not reconciled: paper eGFR 20 to less than 60 ml/min/1.73 m2 (4-variable MDRD); registry "CKD, defined as eGFR 20 - 59 ml/min/1.73m2".
  • Age criterion, worded differently by the sources and not reconciled: paper "an age of 75 years or older"; registry "Age greater than 75 years".
  • Sex: all (registry)
Excluded
  • Diabetes mellitus
  • Prior stroke (registry: "History of stroke (not CE or stenting)")
  • Symptomatic heart failure within 6 months or left ventricular ejection fraction below 35% (registry)
  • Proteinuria above the registry thresholds
  • eGFR below 20 or end-stage renal disease (registry)
  • Polycystic kidney disease (registry)
  • One-minute standing systolic blood pressure below 110 mm Hg (registry)
  • Pregnancy or trying to become pregnant (registry)

  • Effect Interventional Certainty not assessed

    In the same trial and time window, fewer people in the lower-target group died from any cause: 155 of 4678 versus 210 of 4683 (hazard ratio 0.73, 95% CI 0.60 to 0.90).

    Source problem. A cited source is corrected. Check the sources before relying on this claim.

    Applies to Adult
    • Adults aged 50 years or older with systolic blood pressure of 130 to 180 mm Hg (the registry lowers the upper limit as the number of blood-pressure medicines rises) and at least one increased-risk criterion, excluding diabetes mellitus and prior stroke.
    • Outpatient trial clinics at 102 clinical sites. Nursing-home and assisted-living residents were not enrolled.
    • United States, including Puerto Rico
    • Adult, 50 years and over (28.2% of each arm aged 75 or over, per Table 1 of the paper)
    Follow-up Median follow-up 3.26 years when the blood-pressure intervention was stopped early on 2015-08-20. The registry gives a planned maximum follow-up of 6 years. Mean systolic pressure at 1 year was 121.4 mm Hg (intensive) and 136.2 mm Hg (standard).
    Certainty method
    Not assessed
    Limitations
    Secondary outcome. The limits of the primary-effect claim also apply: one open-label trial stopped early for benefit, results the authors do not extend to people with diabetes, prior stroke or age under 50, or to nursing-home residents, and a 2017 erratum whose content was not verified.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (5)

    1. Supports A Randomized Trial of Intensive versus Standard Blood-Pressure Control

      Publication · Massachusetts Medical Society (N Engl J Med 373(22):2103-16) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record. · Published 2015-11-26 · doi: 10.1056/NEJMoa1511939

      Locator
      Abstract, RESULTS, sentence 3: "All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003)."
      How it applies
      Abstract of the primary report, for the same population and follow-up as this context.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0469472c893c84018c2444c15e0a5337926968dadfdd96ad3771f84a69c4e40c
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. Full text not redistributed.

    2. Supports A Randomized Trial of Intensive versus Standard Blood-Pressure Control

      Publication · Massachusetts Medical Society (N Engl J Med 373(22):2103-16) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record. · Published 2015-11-26 · doi: 10.1056/NEJMoa1511939

      Locator
      Results, Clinical outcomes, para 2: "155 in the intensive-treatment group and 210 in the standard-treatment group"
      How it applies
      PMC author manuscript, not the version of record.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. Full text not redistributed.

    3. Supports A Randomized Trial of Intensive versus Standard Blood-Pressure Control

      Publication · Massachusetts Medical Society (N Engl J Med 373(22):2103-16) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record. · Published 2015-11-26 · doi: 10.1056/NEJMoa1511939

      Locator
      Table 2, "All participants" header row: "All participants (N = 4678) (N = 4683)"
      How it applies
      PMC author manuscript, not the version of record.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. Full text not redistributed.

    4. Background A Randomized Trial of Intensive versus Standard Blood-Pressure Control

      Publication · Massachusetts Medical Society (N Engl J Med 373(22):2103-16) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record. · Published 2015-11-26 · doi: 10.1056/NEJMoa1511939

      Locator
      Discussion, para 7: "persons with diabetes, those with prior stroke, and those younger than 50 years of age"
      How it applies
      The groups to whom the authors say the results do not generalize.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. Full text not redistributed.

    5. Background Erratum to "A Randomized Trial of Intensive versus Standard Blood-Pressure Control"

      Publication · Massachusetts Medical Society (N Engl J Med 377(25):2506) · Edition PubMed publication type "Published Erratum". The erratum text was not reachable (HTTP 403) and the PubMed record has no abstract. · Published 2017-12-21 · doi: 10.1056/NEJMx170008

      Locator
      PubMed record of the 2017 erratum (PMID 29262284); the record has no text
      How it applies
      Shows that a correction exists. What it changes, and whether it affects these numbers, is unknown.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0b35286e25986a2083bf5e24855520256cee0d8b58ccbff94f1f70961857ff34
      Reuse basis
      Bibliographic metadata only. The erratum text was not reachable.

  • Effect Interventional Certainty not assessed

    In SPRINT, adults aged 50 and over at raised heart risk, without diabetes or a past stroke, whose treatment aimed for a top (systolic) blood pressure below 120 mm Hg had fewer major heart and blood-vessel events than those aiming for below 140. Over a median of 3.26 years, 243 of 4678 people in the lower-target group and 319 of 4683 in the standard group had a first primary-outcome event (hazard ratio 0.75, 95% CI 0.64 to 0.89).

    Source problem. A cited source is corrected. Check the sources before relying on this claim.

    Applies to Adult
    • Adults aged 50 years or older with systolic blood pressure of 130 to 180 mm Hg (the registry lowers the upper limit as the number of blood-pressure medicines rises) and at least one increased-risk criterion, excluding diabetes mellitus and prior stroke.
    • Outpatient trial clinics at 102 clinical sites. Nursing-home and assisted-living residents were not enrolled.
    • United States, including Puerto Rico
    • Adult, 50 years and over (28.2% of each arm aged 75 or over, per Table 1 of the paper)
    Follow-up Median follow-up 3.26 years when the blood-pressure intervention was stopped early on 2015-08-20. The registry gives a planned maximum follow-up of 6 years. Mean systolic pressure at 1 year was 121.4 mm Hg (intensive) and 136.2 mm Hg (standard).
    Certainty method
    Not assessed
    Limitations
    One open-label trial; outcome adjudicators did not know the assignment. The blood-pressure intervention was stopped early for benefit after crossing a monitoring boundary. The authors say the results do not generalize to people with diabetes, prior stroke or age under 50, or to nursing-home residents. The paper and the registry word the older-age entry criterion differently ("75 years or older" versus "greater than 75 years"), and this is not reconciled. The publication has a 2017 erratum whose content was not verified. Full-text figures come from the PMC author manuscript.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (8)

    1. Supports A Randomized Trial of Intensive versus Standard Blood-Pressure Control

      Publication · Massachusetts Medical Society (N Engl J Med 373(22):2103-16) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record. · Published 2015-11-26 · doi: 10.1056/NEJMoa1511939

      Locator
      Abstract, RESULTS, sentence 2: "hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001"
      How it applies
      Abstract of the primary report, for the same population and follow-up as this context.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0469472c893c84018c2444c15e0a5337926968dadfdd96ad3771f84a69c4e40c
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. Full text not redistributed.

    2. Supports A Randomized Trial of Intensive versus Standard Blood-Pressure Control

      Publication · Massachusetts Medical Society (N Engl J Med 373(22):2103-16) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record. · Published 2015-11-26 · doi: 10.1056/NEJMoa1511939

      Locator
      Results, Clinical outcomes, para 1: "243 (1.65% per year) in the intensive-treatment group and 319 (2.19% per year) in the standard-treatment group"
      How it applies
      PMC author manuscript, not the version of record.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. Full text not redistributed.

    3. Supports A Randomized Trial of Intensive versus Standard Blood-Pressure Control

      Publication · Massachusetts Medical Society (N Engl J Med 373(22):2103-16) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record. · Published 2015-11-26 · doi: 10.1056/NEJMoa1511939

      Locator
      Table 2, "All participants" header row: "All participants (N = 4678) (N = 4683)"
      How it applies
      PMC author manuscript, not the version of record.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. Full text not redistributed.

    4. Supports Systolic Blood Pressure Intervention Trial (SPRINT)

      Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition Record as of the last update submitted 2020-12-11 and posted 2021-01-08. First posted 2010-09-21 (marked estimated). Results first posted 2017-12-04. · nct: NCT01206062

      Locator
      resultsSection, primary outcome measure (posted results 243 of 4678 and 319 of 4683; HR 0.75, 0.64 to 0.89)
      How it applies
      The registry posted results equal the paper's figures.
      Retrieved
      Source effective date
      2021-01-08
      Source state
      Current
      Snapshot hash
      67c6195a32189455b608076fe2b490395dc14cc6e8bec40006e9a817b7f6d0ae
      Reuse basis
      Registry record. The raw API JSON is committed at research/snapshots/ctgov-NCT01206062.json. The ClinicalTrials.gov terms page is rendered by JavaScript and its text was not read, so the redistribution basis is unverified. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) that registries allow short quotations with attribution. This source's terms are unverified or reserve all rights, so any quotation stays short.

    5. Background A Randomized Trial of Intensive versus Standard Blood-Pressure Control

      Publication · Massachusetts Medical Society (N Engl J Med 373(22):2103-16) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record. · Published 2015-11-26 · doi: 10.1056/NEJMoa1511939

      Locator
      Methods, Study population, para 1: "or an age of 75 years or older"
      How it applies
      Paper wording of the older-age criterion.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. Full text not redistributed.

    6. Background Systolic Blood Pressure Intervention Trial (SPRINT)

      Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition Record as of the last update submitted 2020-12-11 and posted 2021-01-08. First posted 2010-09-21 (marked estimated). Results first posted 2017-12-04. · nct: NCT01206062

      Locator
      eligibilityModule.eligibilityCriteria: "Age greater than 75 years"
      How it applies
      Registry wording of the older-age criterion differs from the paper and is not reconciled.
      Retrieved
      Source effective date
      2021-01-08
      Source state
      Current
      Snapshot hash
      67c6195a32189455b608076fe2b490395dc14cc6e8bec40006e9a817b7f6d0ae
      Reuse basis
      Registry record. The raw API JSON is committed at research/snapshots/ctgov-NCT01206062.json. The ClinicalTrials.gov terms page is rendered by JavaScript and its text was not read, so the redistribution basis is unverified. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) that registries allow short quotations with attribution. This source's terms are unverified or reserve all rights, so any quotation stays short.

    7. Background A Randomized Trial of Intensive versus Standard Blood-Pressure Control

      Publication · Massachusetts Medical Society (N Engl J Med 373(22):2103-16) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record. · Published 2015-11-26 · doi: 10.1056/NEJMoa1511939

      Locator
      Discussion, para 7: "persons with diabetes, those with prior stroke, and those younger than 50 years of age"
      How it applies
      The groups to whom the authors say the results do not generalize.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. Full text not redistributed.

    8. Background Erratum to "A Randomized Trial of Intensive versus Standard Blood-Pressure Control"

      Publication · Massachusetts Medical Society (N Engl J Med 377(25):2506) · Edition PubMed publication type "Published Erratum". The erratum text was not reachable (HTTP 403) and the PubMed record has no abstract. · Published 2017-12-21 · doi: 10.1056/NEJMx170008

      Locator
      PubMed record of the 2017 erratum (PMID 29262284); the record has no text
      How it applies
      Shows that a correction exists. What it changes, and whether it affects these numbers, is unknown.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0b35286e25986a2083bf5e24855520256cee0d8b58ccbff94f1f70961857ff34
      Reuse basis
      Bibliographic metadata only. The erratum text was not reachable.

  • Safety Interventional Certainty not assessed

    Some serious side effects were more common with the lower target: serious adverse events of low blood pressure, fainting, abnormal blood salt levels (electrolytes), and sudden kidney injury or failure. Serious falls causing injury were not more common.

    Source problem. A cited source is corrected. Check the sources before relying on this claim.

    Applies to Adult
    • Adults aged 50 years or older with systolic blood pressure of 130 to 180 mm Hg (the registry lowers the upper limit as the number of blood-pressure medicines rises) and at least one increased-risk criterion, excluding diabetes mellitus and prior stroke.
    • Outpatient trial clinics at 102 clinical sites. Nursing-home and assisted-living residents were not enrolled.
    • United States, including Puerto Rico
    • Adult, 50 years and over (28.2% of each arm aged 75 or over, per Table 1 of the paper)
    Follow-up Median follow-up 3.26 years when the blood-pressure intervention was stopped early on 2015-08-20. The registry gives a planned maximum follow-up of 6 years. Mean systolic pressure at 1 year was 121.4 mm Hg (intensive) and 136.2 mm Hg (standard).
    Certainty method
    Not assessed
    Limitations
    Event counts and rates are in Table 3 and supplementary tables of the paper, which were not extracted. In an open-label trial, participants and study staff knew the assignment when adverse events were recorded. The 2017 erratum content was not verified.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (3)

    1. Supports A Randomized Trial of Intensive versus Standard Blood-Pressure Control

      Publication · Massachusetts Medical Society (N Engl J Med 373(22):2103-16) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record. · Published 2015-11-26 · doi: 10.1056/NEJMoa1511939

      Locator
      Abstract, RESULTS, sentence 4: "Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher"
      How it applies
      Abstract of the primary report, for the same population and follow-up as this context.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0469472c893c84018c2444c15e0a5337926968dadfdd96ad3771f84a69c4e40c
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. Full text not redistributed.

    2. Background A Randomized Trial of Intensive versus Standard Blood-Pressure Control

      Publication · Massachusetts Medical Society (N Engl J Med 373(22):2103-16) · Edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record. · Published 2015-11-26 · doi: 10.1056/NEJMoa1511939

      Locator
      Methods, Randomization and interventions, para 1: "Participants and study personnel were aware of the study-group assignments, but outcome adjudicators were not."
      How it applies
      PMC author manuscript, not the version of record.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. Full text not redistributed.

    3. Background Erratum to "A Randomized Trial of Intensive versus Standard Blood-Pressure Control"

      Publication · Massachusetts Medical Society (N Engl J Med 377(25):2506) · Edition PubMed publication type "Published Erratum". The erratum text was not reachable (HTTP 403) and the PubMed record has no abstract. · Published 2017-12-21 · doi: 10.1056/NEJMx170008

      Locator
      PubMed record of the 2017 erratum (PMID 29262284); the record has no text
      How it applies
      Shows that a correction exists. What it changes, and whether it affects these numbers, is unknown.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      0b35286e25986a2083bf5e24855520256cee0d8b58ccbff94f1f70961857ff34
      Reuse basis
      Bibliographic metadata only. The erratum text was not reachable.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Record details

Record id
cardio:intensive-sbp-lowering
Content hash
becbbaa34e2c3583752034e9cfc3f86e6078d60710f15580e8c7396440198588