Reconciling Systolic Blood Pressure Intervention Trial With Eighth Joint National Commission

ACC/AHA, American College of Cardiology/American Heart Association; BP, blood pressure; DBP, diastolic blood pressure; ESH/ECC, European Society of Hypertension/European College of Cardiology; ISH, International Society of Hypertension; JNC-8, Joint National Conference on Hypertension (eighth); KDIGO, Kidney Disease Improving Global Outcomes; SBP, systolic blood pressure; SPRINT, Systolic Blood Pressure Intervention; STEP, Strategy of Blood Pressure Intervention in Elderly Hypertensive Patients.

Authors and Disclosures

Ekamol Tantisattamo^a,b,c, Anum Hamiduzzaman^a, Peter Sohn^a, Rebecca Ahdoot^a and Ramy M. Hanna<sup>a

a</sup>Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, ^bNephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, Veterans Affairs Long Beach Healthcare System, Long Beach, California and ^cMulti-Organ Transplant Center, Section of Nephrology, Department of Internal Medicine, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA

Correspondence to
Ramy M. Hanna, MD, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, 101 The City Drive South, Orange, CA 92868, USA. Tel: +1 714 456 5142; fax: +1 714 456 6034; e-mail: ramyh1@hs.uci.edu

Conflicts of interest
There are no conflicts of interest.

Sidebar

Key Points

• Although BP targets have been evolved, hypertensive care for at-risk populations such as the elderly should be individualized.

• Conservative BP target recommended by JNC-8 and intensive BP control as per SPRINT should be reconciled to avoid hypotension and subsequent complications.

• Although both SPRINT and STEP revealed cardiovascular benefits of intensive BP control, hypotension is the complication that should be taken into account when implementing the study results, particularly in the elderly population.

• Since CKD patients were the minority of the study populations in both SPRINT and STEP, further studies for BP trials specific to the CKD population are warranted to support suitable BP targets.

• In addition to BP target and underlying co-morbidities of hypertensive CKD patients, accurate BP measurement and social determinants should be considered for implementing BP guidelines to different populations from different socio-economic statuses.