In SPRINT, it is all about the question

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.

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