Effects of Intensive Blood Pressure Lowering Treatment in Reducing Risk of Cardiovascular Events - ESPRIT

Contribution To Literature:

The ESPRIT trial showed that intensive blood pressure control improves outcomes.


The goal of the trial was to evaluate intensive blood pressure (BP) control (systolic BP [SBP] <120 mm Hg) compared with standard BP control (SBP <140 mm Hg) among patients with hypertension.

Study Design

  • Randomized
  • Parallel
  • Blinded

Patients with hypertension were randomized to target SBP <120 mm Hg (n = 5,624) vs. target SBP <140 mm Hg (n = 5,631).

  • Total number of enrollees: 11,255
  • Duration of follow-up: 3.4 years
  • Mean patient age: 65 years
  • Percentage female: 41%

Inclusion criteria:

  • Patients ≥50 years of age
  • SBP 130-180 mm Hg
  • Increased cardiovascular risk, defined as established cardiovascular disease or ≥2 cardiovascular risk factors

Exclusion criteria:

  • Secondary cause of hypertension
  • One-minute standing SBP <110 mm Hg
  • Left ventricular ejection fraction <35%
  • Estimated glomerular filtration rate <45 mL/min/1.73 m2

Other salient features/characteristics:

  • Baseline BP: 147/83 mm Hg
  • Diabetes: 39%
  • Stroke: 27%

Principal Findings:

The primary outcome, cardiovascular death, myocardial infarction, stroke, coronary revascularization, noncoronary revascularization, or hospitalization for heart failure occurred in 3.2% in the SBP <120 mm Hg group vs. 3.6% in the <140 mm Hg group (p = 0.03). The results were the same in tested subgroups (history of stroke or diabetes).

Secondary outcomes:

  • Cardiovascular death: 0.3% in the SBP <120 mm Hg group vs. 0.5% in the SBP <140 mm Hg group (p < 0.05)
  • Stroke: 1.5% in the SBP <120 mm Hg group vs. 1.7% in the SBP <140 mm Hg group (p < 0.05)
  • Syncope: 0.4% in the SBP <120 mm Hg group vs. 0.1% in the SBP <140 mm Hg (p < 0.05)


Among Asian patients with hypertension and a large proportion of diabetes and stroke, intensive BP control improves outcomes compared with standard control. Target SBP <120 mm Hg reduced major adverse cardiac events compared with target SBP <140 mm Hg. Intensive BP control was associated with an absolute risk reduction of major adverse events of 0.4%. Intensive BP control was associated with an increased risk of syncope. The results of this trial are in line with the SPRINT trial, which enrolled <2% Asians and excluded subjects with diabetes or stroke.


Presented by Dr. Jing Li at the American Heart Association Scientific Sessions, Philadelphia, PA, November 13, 2023.

Clinical Topics: Prevention, Hypertension, Vascular Medicine

Keywords: AHA23, Antihypertensive Agents, Hypertension

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