While aggressive blood pressure treatment could prevent 107,500 deaths a year, it may increase risk for complications in adults at high risk for heart disease, based on an analysis of U.S. survey data from 1999–2006.
Published in the American Heart Association journal Circulation, this study assessed the risks and benefits of aggressive blood pressure treatment, which has become a hot topic in recent years.
Current U.S. guidelines recommend medication for patients with a systolic blood pressure (top number in a blood pressure reading) of 140–150 mmHg, depending on age and other medical conditions. High systolic blood pressure significantly increases cardiovascular risk, and when appropriate, medication can help lower blood pressure and risk for heart events.
However, some studies suggest that lowering blood pressure beyond 140 mmHg may have added benefits for patients at high risk for heart disease. For example, the SPRINT trial, which compared aggressive versus standard treatment, found that reducing systolic blood pressure to 120 mmHg instead of 140 mmHg reduced mortality risk by 27% in high-risk patients. But lowering blood pressure too much can also carry risks. The mixed findings have caused confusion around what the ideal goal for blood pressure should be for patients with high cardiovascular risk.
To further explore the issue, researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES), which collects data on the health and lifestyle of Americans. The goal of the recent analysis was to compare findings of the SPRINT trial to those in larger, more diverse population of U.S. adults.
A total of 18.1 million U.S. adults were included in the study, all of which completed health questionnaires and medical exams between 1999 and 2006. The average age of participants was 69, and based on medical assessments, all participants had both high blood pressure and high risk for heart disease. However, only 7.4 million reported taking blood pressure-lowering drugs, while 10.7 million were not on blood pressure medication.
After following participants through 2011, researchers calculated that the average annual mortality rate was 2.2%. Based on data from the SPRINT trial, intensive blood pressure treatment could have prevented 107,500 deaths a year in this population. However, aggressive treatment would have also caused a number of complications in tens of thousands of adults. For example, researchers estimate that intensive treatment would have caused 56,100 episodes of low blood pressure, 34,400 episodes of fainting caused by low blood pressure, and 88,700 cases of kidney damage.
The take-home message, as authors explain, is that intensive blood pressure treatment carries both risks and benefits. While tight blood pressure control may help prevent heart events and reduce risk for death, it may increase risk for complications like kidney damage and low blood pressure in certain adults. Thus, it’s important to consider both pros and cons when discussing treatment goals for blood pressure treatment. Authors also hope that with further research, we can better identify patients that will benefit most from aggressive treatment while minimizing risk of complications.