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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 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 !

Reference 

1.A Randomized Trial of Intensive versus Standard Blood-Pressure Control The SPRINT Research Group  N Engl J Med 2015; 373:2103-2116 

2.http://www.acc.org/latest-in-cardiology/articles/2015/12/01/10/04/the-sprint-trial-cons

3.http://www.cardiobrief.org/2017/02/08/new-questions-raised-about-sprint/

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