Patients who got their blood pressure well below today's usually recommended level significantly cut their risk of heart disease and death, the National Institutes of Health announced Friday.
A study found that lowering blood pressure rates to a systolic rate of 120 reduces the rates of heart attack, heart failure and stroke by nearly a third and the risk of death by almost a quarter compared to a rate of 140.
The NIH reported that the benefit was strong enough that NIH stopped the study about a year early.
These results are part of a larger, 9,300-participant study known as the Systolic Blood Pressure Intervention Trial, known as SPRINT.
When the study began in 2009, it was noted that optimal systolic blood pressure to reduce hypertension-related health problems was unclear, "and the benefit of treating to a level of systolic blood pressure well below 140 mm Hg has not been proven in a large, definitive clinical trial."
“This study provides potentially lifesaving information that will be useful to healthcare providers as they consider the best treatment options for some of their patients, particularly those over the age of 50,” Dr. Gary Gibbons, director of the National Heart, Lung and Blood Institute, in a news release.
The American College of Cardiology lauded the study and noted that 70 million American adults have high blood pressure, but only half of them have it under control.
“The preliminary data demonstrates why the cardiovascular community must continue to aggressively fight a condition that leads to stroke, kidney disease and heart problems for our patients,” ACC President Dr. Kim Allan Williams Sr. said in a news release. “The details of the SPRINT trial will be a contributing factor to future guidelines on blood pressure treatment targets. In the meantime, this data gives physicians more information to consider when working to improve outcomes for our patients with high blood pressure.”
A rate of 120 or lower is considered normal, while 140 is considered the beginning of stage 1 hypertension, according to the American Heart Association. While having a rate between 120 and 140 may signal alarms, the NIH noted that “well-established clinical guidelines” recommend a rate of 140 or below for “healthy adults” and 130 for adults with kidney problems or diabetes.
The SPRINT study includes an ethnically diverse group of participants age 50 years and older at 90 clinics in the U.S. and Puerto Rico who were at increased risk of heart disease or had a history of kidney disease. They were randomly split into two groups with one receiving a drug regimen designed to achieve a target systolic rate of 140, and the other, a target rate of 120.
One question is whether older patients need to get their blood pressure as low as middle-aged patients do, or if doing so increases the seniors' risk of side effects including falls. Last year, an expert panel sparked debate by recommending that the treatment target for patients over 60 be a systolic pressure of 150.
The average age of SPRINT participants was 68, and a quarter of them were over 75.
“Our results provide important evidence that treating blood pressure to a lower goal in older or high-risk patients can be beneficial and yield better health results overall,” Dr. Lawrence Fine, chief of the NHLBI's clinical applications and prevention branch, said in the NIH release. “But patients should talk to their doctor to determine whether this lower goal is best for their individual care.”
Other issues being examined in the SPRINT group include kidney disease, cognitive function, and dementia. Data on those issues will continue to be collected “over the next year,” according to the NIH.
