Aggressive Lowering Of Blood Pressure Carries Risks As Well As Benefits

In SPRINT, 9,361 people with systolic blood pressure of 130 mm Hg or higher and at elevated risk for cardiovascular disease but without diabetes were randomized to standard treatment with a blood pressure target under 140 mm Hg or intensive treatment with a blood pressure target under 120 mm Hg. A joint panel of members from the American Heart Association (AHA) and the American College of Cardiology will consider the results as it revises its blood pressure control recommendations, which are due next fall. The study was funded by Australia’s National Health and Medical Research Council.

“Currently, only about half of Americans with high blood pressure are achieving our recommended blood pressure reading of below 140/90 mm Hg”, said Heart Association president Dr. Mark Creager, director of the Heart and Vascular Center at Dartmouth-Hitchcock Medical Center.

“There isn’t going to be another study like this anytime soon”, said Dr. Paul Drawz, who recruited patients to SPRINT in Cleveland before coming to the University of Minnesota three years ago.

The initial analysis of SPRINT, reported in September, 2015, showed that using antihypertensive medications to reach a lower SBP target of 120 mmHg could greatly reduce risk for heart failure, heart attack, and death, compared to a target of 140 mmHg (SBP is the top number in a blood pressure reading).

“Regardless of whether the patients had cardiovascular disease or not, had kidney disease or not, were black or white, male or female, or above or below age 75 – all appeared to benefit similarly”, Dr. Jackson Wright Jr., a blood pressure expert at Case Western Reserve University, told NBC News. About 4.7 percent of patients in the aggressively treated group had serious side effects, such as kidney injury or failure, fainting and severe low blood pressure.

Systolic pressure is the top of the two blood pressure numbers; it indicates the pressure being placed on blood vessels when the heart beats.

The study was supported by contracts and an interagency agreement from the NIH, including the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the National Institute of Neurological Disorders and Stroke. But in the group given more medication to lower blood pressure, just 155 out of 4,678 died.

“The positive results of this trial have taken most investigators by surprise, and the strong benefits of treatment seem to outweigh the risks”, said co-author Alfred Cheung, chief of nephrology and hypertension at University of Utah Health Care. While the financial costs of aggressive treatment are a concern, Jones said, “the good news is that these are not whiz bang drugs that cost a lot of money… majority are generic”. “We saw a few marked blood pressure reductions over trial days when people did the equivalent of walking to the water cooler or a few simple body-weight movements on the spot”.

However in practice, it’s common for physicians to prescribe treatments to patients who may have not been eligible for a clinical trial that demonstrated the efficacy and safety of a particular treatment. When do the benefits kick in between 120 and 140? He also is a member of an expert panel that will update blood pressure treatment guidelines over the next year. The rest got three drugs and aimed for under 120.

Researchers are still analyzing the data to see if more intensive blood pressure lowering affects cognitive decline one way or the other, or has an impact on long-term kidney disease. They’ll now synergize these efforts into a campaign that will further assist both providers and patients by enhancing high blood pressure awareness, understanding and management.

The morning blood pressure surge, on the other hand, is related to physiological factors, including the activation of the sympathetic nervous system, which occurs when you wake up in the morning, Hoshide said.