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Hypertension is a global pandemic of ever growing proportions. It is the most important population attributable risk-factor for ischemic heart disease, stroke and cardiovascular mortality. Appropriate blood pressure (BP) control with antihypertensive agents reduces these cardiovascular complications but very tight BP control can lead to adverse effects like hypotension and renal dysfunction, especially in the elderly. Moreover, the relationship between BP and ischemic heart disease and all-cause mortality follows a J-shaped curve with a signal of higher mortality at low BP ranges. Blood pressure targets across various age and cardiovascular risk groups are not well defined. In the paucity of clinical trial data, many of the BP targets suggested by panels like the Joint National Committee are based on expert consensus. Two recent randomized clinical trials, Systolic Blood Pressure Intervention Trial (SPRINT) and Heart Outcomes Prevention Evaluation (HOPE-3), have extended our knowledge of the BP control paradigm. The SPRINT trial evaluated the benefits of intensive BP reduction to a target systolic BP of 120 mm Hg by addition/up-titration of various antihypertensive medications in a high-risk patient population. The HOPE-3 trial was a primary prevention trial that evaluated the utility of BP lowering in intermediate-risk patients without known cardiovascular disease using a fixed dose drug combination. These trials are discussed in detail in this review.

Clinical Implications of Recent Therapeutic Trials in Hypertension: Insights from SPRINT and HOPE-3 Trials