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HypertensionESPRITNCT04030234

Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing RIsk of Vascular evenTs (ESPRIT) Study

A study testing Intensive BP treatment group and Standard BP treatment group in people with Hypertension, run by China National Center for Cardiovascular Diseases at 1 site in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This trial aims to assess, in patients aged ≥50 years with an average baseline SBP ≥130 mmHg and a previous history of cardiovascular diseases or at high vascular risk, the effects on the incidence of major cardiovascular events during the scheduled treatment period of greater reduction in blood pressure with a SBP… Read more about this study

Who is it for?
Ages 50 years and older
Conditions the study is for
Hypertension
What is being tested?
Intensive BP treatment group and Standard BP treatment group
Could I receive a placebo?
No, everyone receives an active treatment
How many people
11,255 participants
Where
1 siteChina
Study dates
17 Sep 2019to 14 Jul 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • At least ≥50 years old, and
  • Systolic blood pressure (SBP): (having documentation of SBP to meet the criteria below on 2 consecutive visits)
  • SBP: 130-180 mmHg on 0 or 1 medication
  • SBP: 130-170 mmHg on up to 2 medications
  • SBP: 130-160 mmHg on up to 3 medications
  • SBP: 130-150 mmHg on up to 4 medications, and
Show all 17Show fewer
  • Prior vascular disease or at high vascular risk
  • Previous myocardial infarction (MI), percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), at least a 50% diameter stenosis of a coronary, chest pain with objective evidence of myocardial ischemia (load electrocardiogram or load image examination indicated myocardial ischemia)
  • Previous stroke
  • Carotid endarterectomy (CE), or carotid stenting
  • Peripheral artery disease (PAD) with revascularization
  • Abdominal aortic aneurysm (AAA) ≥5 cm with repair
  • Combine with no less than two risk factors below
  • ≥60 years old male or ≥65 years old female
  • Diabetes
  • Dyslipidemia (total cholesterol >200 mg/dL [5.2 mmol/L] or LDL-C >130 mg/dL [3.4 mmol/L] or HDL-C < 40 mg/dL [1.0 mmol/L])
  • Current smoking (smoke more than a cigarette every day in the past 12 months)

Who cannot join

  • Known secondary cause of hypertension
  • An indication for a specific BP lowering medication that the participant is not taking and the participant has not been documented to be intolerant of the medication class
  • One minute standing SBP <110 mmHg (not applicable if unable to stand)
  • Arm circumference too large or small to allow accurate blood pressure measurement with available devices
  • Proteinuria defined as urine dipstick ≥2+ protein at screening
  • Glomerulonephritis treated with or likely to be treated with immunosuppressive therapy
Show all 19Show fewer
  • eGFR <45 ml/min /1.73m2 or end-stage renal disease (ESRD)
  • Previous MI, stroke, or hospitalization for angina, PCI, CABG, CE or carotid stenting, PAD with revascularization, AAA≥5 cm with repair within last 3 months
  • Symptomatic heart failure within the past 6 months or documented left ventricular ejection fraction (by any method) <35%
  • PCI or CABG planned for the next 6 months
  • A medical condition likely to limit survival to less than 3 years, or a cancer (other than non-melanoma skin cancer) diagnosed and treated within the past two years that, in the judgment of local clinical investigators, would compromise a participant's ability to comply with the protocol and complete the trial
  • Any organ transplant
  • Pregnancy, breast-feeding, or of child-bearing potential and not using adequate contraception
  • Any factors judged by local clinic investigators to be likely to limit adherence to interventions. For example,
  • Active alcohol or substance abuse within the last 12 months
  • Plans to move to another place to live for a long time
  • Clinical diagnosis of dementia or mild cognitive impairment (MCI)
  • Currently participation in a clinical trial with an unlicensed drug or device
  • Living in the same household as an already randomized participant

Trial locations and contacts

1 site in 1 country.

China1 site
  • Fuwai Hospital, Chinese Academy of Medical Sciences

    Beijing, 100087

Other trials in China

About this study

This trial aims to assess, in patients aged ≥50 years with an average baseline SBP ≥130 mmHg and a previous history of cardiovascular diseases or at high vascular risk, the effects on the incidence of major cardiovascular events during the scheduled treatment period of greater reduction in blood pressure with a SBP target <120 mmHg versus <140 mmHg.

Read the detailed description

This study is a multicenter, open-label, randomized controlled trial, which will randomize participants aged ≥50 years with an average baseline SBP ≥130 mmHg and a previous history of cardiovascular diseases or at high vascular risk. The study will compare the effects on the incidence of major cardiovascular events of allocation to achieve an intensive SBP goal (SBP <120 mmHg) with a standard SBP goal (SBP <140 mmHg) in four years of follow up.

Conditions
Hypertension
Being tested
Intensive BP treatment group, Standard BP treatment group
Keywords
Hypertension, Blood pressure target
Medical subject headings
Hypertension

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Intensive BP treatment groupDrug

    Also called Control of SBP to <120 mmHg

    Participants in the Intensive BP treatment group have a goal of SBP <120 mmHg. It is recommended to provide long-acting antihypertensive medications, that is once daily, unless other medication delivery frequency is needed. The local investigator may select among the available study antihypertensive medications. Other drugs not supplied by the trial may also be used as the investigator determines appropriate.

    One or more medications from the following classes of agents will be provided by the study for use in managing participants in both randomization groups to achieve study goals:

    Angiotension converting enzyme (ACE)-inhibitors; Angiotension receptor blockers (ARBs); Thiazide-type diuretics; Loop diuretics; Potassium-sparing diuretics; Beta-blockers; Calcium channel blockers (CCBs); Direct vasodilators; Alpha1-receptor blockers; Sympatholytics

  • Standard BP treatment groupDrug

    Also called Control of SBP to <140 mmHg

    Participants in the Standard BP treatment group have a goal of SBP <140 mmHg. The same medications used in the Intensive BP treatment group will be used for the Standard BP treatment group.

Study groups in NCT04030234
Study groupRoleWhat they receive
Intensive treatment groupExperimentalParticipants randomized into the Intensive treatment group will have a goal of SBP <120 mmHg. A two- or three-drug regimen should be initiated at randomization for most participants. Drug doses should be increased and/or additional antihypertensive medications should be added at each visit in the intensive treatment group, usually at monthly intervals, until the participant's goal of <120 mmHg has been reached or the local investigator decides no further antihypertensive medications may be added.
Receives: Drug: Intensive BP treatment group
Standard treatment groupActive comparatorParticipants randomized into the Standard treatment group will have a goal of SBP <140 mmHg. It is expected to achieve a SBP of 135-139 mmHg in as many participants as possible. Medication dose titration or addition of another drug is indicated if SBP is ≥160 mmHg at a single visit or is ≥140 mmHg at two consecutive visits. Down titration should be carried out if the SBP is <130 mmHg at a single visit or <135 mmHg at two consecutive visits.
Receives: Drug: Standard BP treatment group

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of participants with composite of major CVD events

    Composite outcome of myocardial infarction, coronary or non-coronary revascularization, chronic or acute decompensated heart failure hospitalization or emergency department visit, stroke, or death from cardiovascular disease

    Measured: 4 years

Secondary outcomes (11)
  1. Number of participants with myocardial infarction

    Measured: 4 years

  2. Number of participants with coronary revascularization

    Measured: 4 years

  3. Number of participants with non-coronary revascularization

    Measured: 4 years

  4. Number of participants with chronic or acute decompensated heart failure hospitalization or emergency department visit

    Measured: 4 years

  5. Number of participants with stroke

    Measured: 4 years

  6. Number of participants with cardiovascular death

    Measured: 4 years

  7. Number of participants with all-cause death

    Measured: 4 years

  8. Number of participants with composite outcome of the primary composite with all-cause death

    Measured: 4 years

  9. Number of participants with end-stage kidney disease (ESKD), a sustained decline in eGFR to <10 mL/min/1.73m2, renal death, or a sustained decline of ≥40% in eGFR from randomization

    Measured: 4 years

  10. Number of participants with all-cause dementia or mild cognitive impairment

    Measured: 4 years

  11. Difference of arteriole-to-venule ratio measured by fundus photography between intensive treatment group and standard treatment group

    Measured: at 4-year final follow-up visit

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Jul 2019
  2. Study start17 Sep 2019
  3. Primary completion30 Jun 2023
  4. Study completion14 Jul 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
11,255 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04030234
Sponsor's protocol ID
2018YFC1312400
Acronym
ESPRIT
Status last verified
Jan 2024
First submitted
17 Jul 2019
Last updated
20 Feb 2024
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Peng Y, Li Y, Li S, Zhang L, Zhao L, Liu J, Yan X, Liu J, Chai Z, Liang X, Tian C, Huo F, Wu L, Chen X, Che H, Zhang M, Duan R, Wang H, Liu X, Li Z, Liu Z, Wu L, Zhou W, Zhang H, Li J. Achieving Intensive Blood Pressure Control in High-Risk Patients: Implementation Insights From the ESPRIT Trial. J Am Coll Cardiol. 2026 May 12;87(18):2450-2470. doi: 10.1016/j.jacc.2026.01.083. Epub 2026 Apr 1.

    PubMed 41920135
  • Wang B, Sun Y, Li Y, Wu L, Peng Y, Li S, Ge J, Zhang L, Zhao L, Liu J, Su S, Zhang B, Liu Y, Ma X, Zuo Z, Zhang H, Wang Y, Liu J, Li J. Intensive BP Control and Cognitive Function: A Randomized Clinical Trial. Hypertension. 2026 Apr;83(4):e26572. doi: 10.1161/HYPERTENSIONAHA.125.26572. Epub 2026 Feb 26.

    PubMed 41744069
  • Huang X, Zhang H, Li Y, Ge J, Sun Y, Zhang L, Zhao L, Liu J, Zhang C, Du J, Li Y, Zhang H, Hao F, Wang Q, Xu W, Liu J, Li J. Modest Effects of Intensive Blood Pressure-Lowering on Quality of Life in Patients at High Cardiovascular Risk: The ESPRIT Trial. J Am Coll Cardiol. 2025 Oct 28;86(17):1392-1401. doi: 10.1016/j.jacc.2025.06.010. Epub 2025 Oct 17.

    PubMed 41105075
  • Wang B, Shi D, Zhang Z, Zhang L, Sun Y, Liu J, Yan X, Jing J, Li J, Song J, Li Y, Li G, Zhang L, Wang Z, Chen J, Zhang W, Cai S, Han S, Luan T, Yi S, Su S, Du J, Kou X, Liu J, Dai X, Li N, Zhu J, Tang C, Liu S, Su H, Liu Y, Mao Y, Yang X, He M, Zhang Q, Li J. Effect of Intensive Blood Pressure Lowering Treatment on Retinal Microvasculature: Secondary Analysis From ESPRIT. J Am Coll Cardiol. 2025 Oct 28;86(17):1377-1388. doi: 10.1016/j.jacc.2025.05.020. Epub 2025 Oct 17.

    PubMed 41105073
  • Li S, Peng Y, Li Y, Sun Y, Yan X, Zhang L, Liu J, Zhao L, Liu J, Qian J, Zhai N, Dong L, Ruan J, Zhang P, Wei X, Liu Y, Ma Q, Huang W, Zhang Q, An C, Liu J, Sheng L, Zhang H, Li J; ESPRIT Investigators. Effects of Intensive Blood Pressure Control in Patients With Frailty: A Post Hoc Analysis From ESPRIT. J Am Coll Cardiol. 2026 Jan 6;87(1):4-16. doi: 10.1016/j.jacc.2025.08.092. Epub 2025 Oct 15.

    PubMed 41091084
  • Liu J, Li Y, Ge J, Yan X, Zhang H, Zheng X, Lu J, Li X, Gao Y, Lei L, Liu J, Li J; ESPRIT Collaborative Group. Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial. Lancet. 2024 Jul 20;404(10449):245-255. doi: 10.1016/S0140-6736(24)01028-6. Epub 2024 Jun 27.

    PubMed 38945140
  • Saiz LC, Gorricho J, Garjon J, Celaya MC, Erviti J, Leache L. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev. 2022 Nov 18;11(11):CD010315. doi: 10.1002/14651858.CD010315.pub5.

    PubMed 36398903
  • Saiz LC, Gorricho J, Garjon J, Celaya MC, Erviti J, Leache L. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev. 2020 Sep 9;9(9):CD010315. doi: 10.1002/14651858.CD010315.pub4.

    PubMed 32905623

Questions about this trial

What is this clinical trial studying?

A study testing Intensive BP treatment group and Standard BP treatment group in people with Hypertension, run by China National Center for Cardiovascular Diseases at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 17 inclusion and 19 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 20 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Number of participants with composite of major CVD events (time frame: 4 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04030234, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Feb 2024.

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