Very low SBP targets and the boom-and-bust cycle of benefit and adverse kidney events

This editorial reviews long-term follow-up data from the SPRINT trial, examining outcomes of intensive (<120 mmHg) versus standard (<140 mmHg) systolic blood pressure targets in hypertensive patients at high cardiovascular risk. While intensive treatment initially reduced cardiovascular events and mortality, these benefits disappeared by 8.6 years as blood pressure drifted back toward baseline in real-world follow-up, and intensive control was linked to higher short-term rates of kidney adverse events, including a 3.5-fold increase in incident CKD. The authors argue that very low SBP targets may not be feasible to sustain outside trial conditions, and compare SPRINT with the STEP and ESPRIT trials to suggest a more achievable range of 110–<130 mmHg may better balance cardiovascular benefit against kidney safety.