ó A dramatically lower systolic blood pressure ó that big
number after the blood-pressure cuff has deflated ó may be
necessary to reduce risk of cardiovascular and kidney disease
and even death.
guidelines to keep systolic blood pressure below 140
millimeters of mercury (mm Hg) might need to plummet below 120
to reduce the health risks of hypertension.
panic and donít let your blood pressure spike. Just stay
would say to wait for more information," said Indu
Poornima, the Allegheny General Hospital director of nuclear
medicine and director of the hospitalís Womenís Heart
Center. "But itís always worthwhile to have a
discussion with your doctor to see if the patient would
benefit with a more aggressive target."
11, the National Heart, Lung, and Blood Institute stopped its
Systolic Blood Pressure Intervention Trial, or SPRINT, when
results showed that patients maintaining systolic
blood-pressure levels below 120 experienced 30 percent fewer
cardiovascular events ó heart attacks, heart disease and
strokes ó than those following current guidelines of below
140, reporting 25 percent fewer deaths.
and Safety Monitoring Board that monitors such studies
recommended the trial be halted. It would be unethical to deny
all 9,300 study participants the option of seeking better
blood pressure control to reduce health risks.
NHLBI now is analyzing results before publishing them in a
medical journal while continuing part of the study focused on
whether elevated blood-pressure levels affect cognitive
function in older adults.
working hard to finish the paper and submit it to a journal. I
donít want to specify a date, but it will be within a few
months," said Lawrence Fine, NHLBIís SPRINT project
officer. "Once a paper of this kind with these kinds of
results is published, Iím sure that any future guideline
group will look at it and integrate it with other research
into their recommendations for new guidelines.
job is to provide research information to the larger
scientific community and health professionals, so when you
have a trial like this one thatís completed successfully, we
feel we accomplished our mission," he said.
the study, participants were divided into two groups, one
using medications to reach a targeted systolic rate of less
than 140, which on average required two hypertension
medications. The intensive-treatment group on average received
three medications to keep levels below 120.
trial involved 100 health centers in the United States and
Puerto Rico, including a local University of Pittsburgh trial
involving 140 patients. SPRINT didnít include patients with
diabetes or those whoíve had strokes or polycystic kidney
disease because other studies have focused on those
populations, with a current blood-pressure target below
to the institute, "high blood pressure, or hypertension,
is a leading risk factor for heart disease, stroke, kidney
failure, and other health problems"; one in three adult
Americans (about 78 million) having the condition. The World
Health Organization and other medical organizations say high
blood pressure poses the greatest risk for disease and death.
pressure is measured as a ratio of systolic pressure ó the
pressure in arteries when the heart beats (or heart muscle
contracts) ó over diastolic pressure, which is arterial
pressure between heart beats, according to
evidence, however, that the risk of cardiovascular disease
begins rising at 115/80, said Jackson Wright, an
Pittsburgh-area native who led one of five research networks
in the SPRINT study at the University Hospitals Case Medical
Center in Cleveland. He also directs the centerís clinical
very clear that relaxing treatment for blood pressure control
over age 60 no longer is appropriate," Dr. Wright said,
noting the average trial participant age was 68, with 28
percent older than 75.
SPRINT findings hold up, guideline targets should be lowered,
he said. "The question obviously is what to do with
patients at 120, and at what point do you use aggressive
control with medications rather than changes in
awaiting study results, Dr. Wright said, "the last thing
I want to do is relax blood-pressure control."
likewise begs the question of whether patients and doctors
should take immediate action to reduce blood pressure or await
hard to tell other health care providers how they should
react, but this will prompt discussion for all patients over
50 with high blood pressure who donít only have
hypertension, but a high risk of cardiovascular disease,
chronic kidney disease or past cardiovascular events,"
said Molly B. Conroy, site principal investigator for SPRINT
at Pitt, where sheís an associate professor of medicine and
epidemiology. "What this will cause me to do with
patients with high blood pressure is to make them aware of the
new impact treatment can have and start a discussion of
whether intensifying medication would be appropriate,"
drugs ó including ace inhibitors, diuretics, calcium channel
blockers and beta blockers ó especially for elderly patients
can pose side effects including lightheadedness that boosts
the risk of falling. They also can lead to fatigue and drain a
person of stamina. Others might cause allergic reactions,
while calcium channel blockers can cause ankles to swell, Dr.
news is that most of the drugs are available in generic form
at reduced costs.
Poornima at Allegheny General Hospital said trial results donít
surprise her. She already has witnessed better results among
her own patients at levels below 120/80. While it may be too
early to put trial results into action, "it calls
attention to goals of blood pressure being lower, and if that
is demonstrated in the study, then it would mean changes in
blood-pressure management," she said.
she said, sheís more aggressive in younger patients and
those at higher risk for cardiovascular or kidney disease,
with hopes that trial results will better explain the impacts
of tighter control in different age groups and disease levels.
was expecting (SPRINT results) would be the case because I
always believed you target levels closer to normal," Dr.
Poornima said. "Thatís what we should aim for,"