To the Editor We believe that the mechanisms underlying the results of SPRINT,1 and the analysis of patients aged 75 years or older,2 warrant further discussion. Untreated hypertension poses a particular risk of stroke and myocardial infarction in a short time window, which may be mitigated by blood pressure reduction. On the other hand, left ventricular hypertrophy, diastolic dysfunction, and overt heart failure secondary to hypertension tend to develop over a longer period (decades) and their prevention by lowering of blood pressure could take a longer period to manifest. It was therefore unexpected to note the statistically nonsignificant reduction in stroke and myocardial infarction events in both studies, in contrast to a clear reduction in incident heart failure and all-cause mortality.
Andersson C, Vasan RS. Intensive vs Standard Blood Pressure Control for Older Adults. JAMA. 2016;316(18):1922-1923. doi:10.1001/jama.2016.14927