You Don’t Know It But The Debate About SPRINT Is Already Over

On Monday you’re going to hear a lot– an awful lot– about SPRINT. That’s the big NIH blood pressure trial which was stopped early. On September 11 an NIH press release trumpeted the positive results without revealing most of the important details. This Monday, finally, the results are scheduled to be presented at the American Heart Association meeting in Orlando, Florida and may well be published simultaneously in a distinguished medical journal.

Now you might think that this will be the start of a long discussion and perhaps debate about the trial results and how to interpret  and apply them. That would be a reasonable idea, but you would be completely wrong. In fact, it will be the end of the real discussion. There may be a lot of public talk about the trial but it’s highly likely that all the people who count already know the results and have worked out among themselves how these results will be applied to guidelines and clinical practice.

By way of example, let me tell you what happened 18 years ago, when another big and important hypertension trial came along. In 1997 the trial of the year was the Systolic Hypertension in Europe (SYST-EUR) trial, which was presented in June of that year at the European hypertension meeting in Milan. This was a landmark trial that changed the focus of hypertension treatment from the diastolic to the systolic blood pressure number. It was a really big deal at the time.

A few weeks before SYST-EUR came out I attended the annual meeting of the American Society of Hypertension meeting in San Francisco. In addition to wondering about SYST-EUR, everyone was also speculating about the details of the next generation of the hypertension guidelines (JNC), scheduled to come out later that year.

It occurred to me that the JNC members might have a difficult time incorporating the results of an important trial like SYST-EUR into the new guidelines in a very short period. So I asked one of the members of the JNC, a world class hypertension expert, about this problem. He assured me, with the slightly bemused air of someone stating the obvious, that there was no need for me to worry. The results of SYST-EUR had already been fully incorporated into the new JNC guideline.

So I am looking forward to seeing the results of SPRINT and following the discussion. I am sure there will be a lot of debates. But I don’t imagine that any of it will likely have a big impact, since all the important decisions about SPRINT have almost certainly already been made.

One last point: I don’t for a moment imagine that there is anything unique to the hypertension community here. I’m sure this goes on all the time in all the major areas of medicine.

One last question: what does this say about the embargo system? What exactly is it designed to protect?

 

 

Comments

  1. Franz Messerli says:

    Of note, Syst-Eur clearly established safety and efficacy of CCBs in the elderly. As a result the JNC VI stated on treating the elderly with isolated systolic hypertension “Long-acting dihydropyridine calcium antagonists are considered to be appropriate alternatives (to thiazides) in these patients.” This statement caused some members of the JNC to resign since they refused to accept that the much-maligned CCBs could indeed be an acceptable therapeutic option. Sic tempora mutantur…

    Franz Messerli, MD

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