Lower blood pressure? UW doc covers what you need to know about new study...
Janill Gilbert stashed this in Health
A UW Medicine cardiologist answers top questions about a landmark national study that found that dramatically lowering blood-pressure targets for some people reduces heart-related harm, and deaths.
Details were released Monday from a landmark federal study about the potential benefits of reducing blood pressure below current targets, a move that could change standard thinking about hypertension, which affects more than 70 million people in the U.S., including about 1.6 million in Washington state, health data show.
The study, dubbed the Systolic Blood Pressure Intervention Trial — or SPRINT — was stopped in September, nearly two years early, when it became clear that radically lowering blood pressure for many people older than 50 helped prevent heart attacks and other heart problems and deaths. At the time, specific details, including information about side effects, were not revealed.
Full results were presented Monday at a meeting of the American Heart Association in Orlando, Fla., and were published online in the New England Journal of Medicine.
About the study
No local doctors were involved in the work, but The Seattle Times asked Dr. Eugene Yang, a cardiologist and medical director of the UW Medicine’s Eastside Specialty Center, to answer the most common questions that consumers in Seattle and beyond might have about the important study.
Here’s a short guide to what you need to know:
Why was the study done? One in three adults in Washington state, as well as in the U.S., has high blood pressure, with readings of 140/90 or more. Normal is 120/80. The SPRINT study aimed to tell whether lowering systolic pressure to 120 or to 140 was beneficial.
“There have been a lot of controversies about how aggressively to treat high blood pressure,” Yang noted.
What did the study involve? More than 9,300 people older than 50 were enrolled in the study with systolic pressure of 130 or higher. Half received two drugs or more, on average, to reduce their blood pressure to less than 140, and half received three drugs with a target goal of 120.
One important note, Yang said, is that the study excluded high-risk patients, including those with diabetes, a history of stroke and other problems.
What were the results? After a year, 1.65 percent of the intensive-treatment group had a heart attack or other major cardiovascular problem, or died, compared with 2.1 percent in the standard-treatment group. There were 155 deaths in the intensive-treatment group and 201 in the standard-treatment group, a 27 percent reduced risk.
Side effects such as too-low blood pressure, fainting and serious problems such as kidney failure were 1 to 2 percent higher in the group with lower blood pressure. But a feared complication, falls caused by lightheadedness, especially in older people, wasn’t more common.
But Yang noted that the number of people who would need to be treated in order to achieve the benefits didn’t meet the bar for changing treatment practice. And, he added, the side effects could significantly affect quality of life in some patients, particularly those who are older.
“These are the kinds of things you need to consider in more aggressive blood-pressure treatment,” he said.
What does it mean for me? The results include people older than 50 who had blood-pressure readings of 130 or higher. People at higher risk, including those with diabetes, were not included. It isn’t a blanket call to cut blood-pressure goals, Yang said.
“It doesn’t mean that everybody over 50 who met the inclusion criteria should be targeted to a blood pressure of lower than 120,” Yang said.
People concerned about their own blood-pressure levels should talk to their health-care providers about whether it would be helpful to try to achieve lower readings, he added.
Will this change practice? Yang said he wished the study hadn’t been terminated so soon, so that researchers would have even more data about the effects of drastically reducing blood pressure.
“Honestly, I don’t know why they ended this study early,” he said. “Why not continue to look at the outcomes in order to make sure?”
Yang said he’ll consider the results, but patients shouldn’t expect bold changes right away.
This is the most telling for me:
"Will this change practice? Yang said he wished the study hadn’t been terminated so soon, so that researchers would have even more data about the effects of drastically reducing blood pressure.
“Honestly, I don’t know why they ended this study early,” he said. “Why not continue to look at the outcomes in order to make sure?”"
Yeah, that seems like bad science.
Blood pressure does not seem like it exists in isolation.
Seems like it's the symptom of another affliction.
So a blanket statement like "get your blood pressure down" seems needlessly general.
And I wouldn't change my practice based on this study, too.