Perils of sixth sense : SPRINT trial, a false GOD in a hypertensive world !

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Perils of sixth sense : SPRINT trial, a false GOD in a hypertensive world !

November 18, 2017 by dr s venkatesan

One big hypertension trial called SPRINT was published in 2015, has caused major delayed aftershocks in the hypertensive world now in 2017.

The new guidelines by 2017 AHA/ACC is based primarily on SPRINT data which in my opinion has so much flaws it shouldn’t have been accepted for publication in the first place. !(Intentions and Aim of a study can never be questioned even by most prestigious journals you know !)

The flaws begin right from study design itself. Why diabetic population was excluded from the SPRINT trial is not clearly answered in the true interest of public.The Ironical argument is diabetic patients had no benefit with intensive BP management in ACCORD study. So why waste another study ! Funny is in’t?
When CVD risk profile is intimately linked with these two major entities (DM/HT) it defies sense to exclude one them from the study, which is going to assess population based total CVD risk reduction.
Another dramatic confounder is , 90% of SPRINT patients were taking baseline anti HT drugs. So, the original pressure of these people (No,they are patients really !) should have been high . (If you apply this logic , SPRINT study conclusions will not apply for general population who are healthy and free from drug intake! )
SPRINT trial also concluded there is little benefit in acute MI and renal protection. The main benefit that tilted in favor of SPRINT was preventing episodes of cardiac failure which was defined by the primitive , subjective , ever unreliable symptomatology of exertional dyspnea.

The ultimate spoiler in SPRINT

The modality of BP measurement in SPRINT trial can be termed as as a single fit case for rejecting the study in the world hemodynamic court !

We know BP is a continuous variable, between machines , timing of measurement, persons who measure , hand to hand , beat to beat variation etc etc. The SPRINT BP data was accrued high-profile “Research standard BP” measured by oscillometry method. Please hold your breath , . . these machines never measure either systolic or diastolic BP.It detects the peak oscillations from brachial artery when the cuff is deflated and ask the vendor dependent fuzzy logic algorithm to do a guess work of SBP and DBP , which proudly flashes them in various LED colors.

The jury is still out whether the methodology is validated or not. SPRINT data should be thoroughly sanitized with a true clinic BP which would virtually mean , recall of this (de) famed study !

Final message

How can such a flawed study be taken as reference for creating major revision of Hypertension guidelines?

This question is to be asked in chorus by all respectable physicians and cardiologists.The World health organisation -WHO , custodian of human health and the silent watch “puppy” has more work to do ! . . please WHO , wake up and bark !