DEAR DOCTOR K:
A few months ago, I read that results from a big trial were going to change blood pressure treatment goals. Where do things stand now?
I’ll bet you’re referring to SPRINT. In September 2015, the National Institutes of Health (which funded the study) reported that the study had been stopped earlier than planned because its results were clear. Recently, the complete report of the study (called SPRINT) and its results was published in The New England Journal of Medicine.
SPRINT researchers examined whether a lower systolic blood pressure (the top number) target of 120 or less would be better than a target of 140 in patients with hypertension (high blood pressure). To do so, they recruited 9,361 patients who were at increased risk for cardiovascular disease and who had a systolic blood pressure of 130 or higher. They randomly assigned them to either standard treatment or to intense treatment.
Standard treatment meant using medicines to drive down systolic blood pressure to less than 140. Intense treatment meant driving down systolic blood pressure to less than 120. Compared to people who received standard treatment, those who got intense treatment had:
- 25 percent fewer cardiovascular complications: fewer heart attacks, episodes of heart failure and strokes;
- 27 percent reduction in the risk of death.
Study participants in the intense treatment group needed three medications, on average, instead of two, to achieve lower systolic blood pressure. Not surprisingly, this resulted in more side effects such as blood pressure that was too low, fainting and temporary kidney failure.
Also, the results may not apply to everyone at increased cardiovascular risk who has high blood pressure. For example, patients with diabetes, heart failure, a previous stroke, or who were younger than 50, were not enrolled in the trial. Those with a very high blood pressure (systolic of 180 or greater) were also excluded from the study.
High blood pressure often doesn’t produce symptoms. Many people who have hypertension don’t even know it. If you don’t know your blood pressure, this trial should prompt you to find out.
If you already have high blood pressure, make an appointment to see your doctor. Together, you should determine if you need more aggressive blood pressure management.
Patients sometimes ask me why it is that doctors keep treating high blood pressure, high cholesterol and other health risk factors more aggressively. They wonder if maybe the drug companies are pushing doctors to prescribe more drugs.
It surely is true that over the years doctors have been using medicines to drive blood pressure and blood cholesterol levels down. But the reason is that scientific studies have shown that such aggressive treatment improves the health of patients. The SPRINT study is another example of that.
Sometimes, studies show the opposite. For example, studies have recently shown that we were often pushing too hard to lower blood sugar levels in people with diabetes. That has caused most doctors to be less aggressive in treating blood sugar. When we change practice, it’s because we follow the science, wherever it leads.