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What you should know about the SPRINT blood pressure trial

BPNew data, published Monday, from the Sprint blood pressure trial could inspire a second look at the blood pressure treatment guidelines that doctors follow today.

The large study showed lowering systolic blood pressure from the currently recommended 140 to less than 120 could prevent heart attacks and strokes and potentially save lives. While the study is compelling, there are important things to know about it.

First, the study is not a mandate to treat everyone so their blood pressure is below 120

The Sprint trial included people age 50 and older who had blood pressure readings between 130 and 180. Study participants did not have diabetes and had never experienced a stroke, plus had normal kidneys. About 16 million American adults would fit the study criteria.

While the results are strong enough to lead to significant changes in patient care, says Robert Brook, M.D., a hypertension specialist at the University of Michigan Frankel Cardiovascular Center, this does not mean that everyone over 50 years old needs to have an urgent visit to their health care provider. “Rather we are learning that there are real benefits to more aggressive goals, if blood pressure can be lowered safely,” he says.

Keep in mind that a systolic goal of less than 140 is well-proven to reduce cardiovascular events compared to higher levels.

“The study results should lead to discussion about heart disease risk before resulting in new prescriptions,” says Kenneth Jamerson, M.D., a University of Michigan hypertension specialist and principal investigator of an  international clinical trial to study best ways to treat high blood pressure. “Most study participants achieved the lower target with three medications. At this time it is not advisable to use four, five or six medications in an attempt to achieve the 120 target.”

One way part of the discussion: calculating the Framington risk score which predicts the chances of having a heart attack in the next 10 years. A risk of 20 percent or more is a sign that tighter blood pressure control could be helpful.

Second, the potential benefits of lowering blood pressure must be weighed against harms

As expected, treating people with more medications to lower their blood pressure caused some harm. The side effects of intensive treatment included fainting, kidney injury and dangerously low blood pressure, but the benefits were dramatic, and the risks less so.

“Any side effect is important to the person who suffers it, so the risks and benefits of a lower blood pressure goal must be carefully considered for each patient,” says Brian Byrd, M.D., M.S., U-M cardiologist and hypertension specialist.

Third, study provides solid support for tighter blood pressure goals but more information is needed about who benefits most

The study provided solid support for intensive treatment for many, but not everyone, says Susan Steigerwalt, M.D., a nephrologist and hypertension specialist at the University of Michigan Frankel Cardiovascular Center.

It’s not clear if those under age 50, diabetics or those with low heart disease risk should do anything different.

Another important aspect of the study was that the blood pressure was measured sitting in a quiet area for five minutes, using an automated machine that took three readings.  The study did not include readings from outside the doctor’s office where stress at home or work can make blood pressure go up.

“There’s an assumption that the dangers of high blood pressure accumulate over a lifetime, but Sprint showed a life-saving benefit in just three years of more intense treatment,” says Steigerwalt. “That makes the results all the more compelling.”

Patients should keep taking medications as recommended and talk with their doctor about their heart disease risk.  A healthy lifestyle that includes salt moderation, daily physical activity, adequate sleep and weight control remain the best ways to avoid high blood pressure.

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