'SPRINT'–ing Toward Lower Blood Pressure Targets
Arguably one of the most significant trials of 2015 was the Systolic Blood Pressure Intervention Trial (SPRINT) Trial, which found that lowering systolic blood pressure targets to less than 120 mm Hg vs. 140 mm Hg may lower the rate of cardiovascular events and allcause mortality in non-diabetic adults with hypertension. Given these findings, a recent CardioSurve survey sought to understand cardiologist perceptions of the importance of clinical trials in treatment decisions with a focus specifically on the SPRINT Trial.
The survey of 185 FACCs finds that the vast majority of cardiologists view guidelines and clinical trials of nearly equal and significant importance to their patient treatment decisions. Approximately nine out of 10 cardiologists believe that Clinical Practice Guidelines (91%) and Clinical Trials (88%) are very/extremely important when considering patient treatment decisions. By comparison seven out of 10 cardiologists (69%) view Appropriate Use Criteria and half (51%) view Performance Measures as very/ extremely important to their patient treatment decisions.
Given this importance of clinical trials in patient treatment decisions, the survey also indicates that the majority of cardiologists (57%) feel that guidelines should be updated when there is new information that requires changes to the content or recommendations. Additionally, one out of four cardiologists (24%) believes that guidelines should be updated continuously as a "living" electronic document.
In focusing on the SPRINT Trial, more than nine out of 10 cardiologists in the survey (94%) have patients they are treating for hypertension. Not surprisingly, most clinicians (60%) are very or extremely familiar with the SPRINT Trial results — especially cardiologists in smaller CV practices (67%). In terms of the impact of SPRINT on patient treatment decisions, overall, 59 percent of cardiologists indicate that they are likely to change their hypertension treatment targets based upon SPRINT, although much of this is soft (44% somewhat likely). As expected, those cardiologists very familiar with the SPRINT Trial are much more likely (69%) to change their hypertension targets than those less familiar with it (44%).
Clearly, the cardiovascular community is taking note of the results and their potential to change practice. "The SPRINT Trial showed significant benefits of intensive BP treatment," states one cardiologist from Michigan. "The impressive morbidity and mortality benefits cannot be overlooked," volunteers another from Kentucky.
Other cardiologists highlighted the importance of the results, but said they were not planning on changing their targets based on SPRINT alone. "A single positive study still has to be considered in the context of other clinical trial results," explained one cardiologist from California. Along these lines, one out of five cardiologists (19%) says that changing hypertension targets more strongly depends upon the patient scenario or that they are waiting until the updated ACC/American Heart Association guidelines are published later this year. As one cardiologist from Mississippi states, "I understand that SPRINT is a big clinical trial with a huge impact. However, I would like the guidelines to change first."
Although currently a diversity of opinion exists in regards to implementation, it is clear that the SPRINT Trial has caused clinicians to consider reevaluating the treatment of their patients with hypertension. "The ramifications of the SPRINT trial if applied to patients with hypertension throughout the U.S. and indeed the world are profound," says Kim A. Eagle, MD, MACC, editor-in-chief of ACC.org. For more information on the SPRINT Trial, including expert commentary, video interviews and news, visit the ACC's SPRINT Trial "hub" at ACC.org/SPRINT.
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