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LetterLetters

In SPRINT, it is all about the question

David Allen
Canadian Family Physician October 2016; 62 (10) 795;
David Allen
Sudbury, Ont
MD FCFP
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I thank Allan et al for their summary of the evidence concerning blood pressure (BP) targets,1 but SPRINT (Systolic Blood Pressure Intervention Trial) illustrates a dilemma that we often face, in which the answer we are given does not answer the question we are asking.2 In this case, it does not even answer the question that the SPRINT authors were asking. I would like to know whether a target systolic BP of less than 120 mm Hg is superior to a target of less than 140 mm Hg. The SPRINT researchers actually answered the question of whether a target of less than 120 mm Hg is superior to a target of 135 to 139 mm Hg. In SPRINT, a participant with a systolic BP of 128 mm Hg would have had his or her medication either increased or decreased, depending on which arm he or she was in. In real life, I would have likely said, “Your BP is good. Let’s keep your pills where they are.” This would not have been an option in SPRINT. We often have to make real-life decisions based on evidence that does not answer our question. The SPRINT authors gave us useful information. We just have to remember that SPRINT did not really answer the question it appeared on the surface to be studying.

Footnotes

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Allan GM,
    2. Garrison S,
    3. Padwal R
    . SPRINT to evidence for specific blood pressure targets. Can Fam Physician 2016;62:638. (Eng), e437–8 (Fr).
    OpenUrlFREE Full Text
  2. 2.↵
    1. SPRINT Research Group,
    2. Wright JT Jr.,
    3. Williamson JD,
    4. Whelton PK,
    5. Snyder JK,
    6. Sink KM,
    7. et al
    . A randomized trial of intensive versus standard blood- pressure control. N Engl J Med 2015;373(22):2103-16. Epub 2015 Nov 9.
    OpenUrlCrossRefPubMed
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Canadian Family Physician: 62 (10)
Canadian Family Physician
Vol. 62, Issue 10
1 Oct 2016
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Canadian Family Physician Oct 2016, 62 (10) 795;

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