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The New Blood Pressure Debate: Is Lower Always Better?

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Back in September, The New York Times was nearly breathless: Lower Blood Pressure Guidelines Could Be ‘Lifesaving,’ Federal Study Says. The new SPRINT study, they reported, made it clear that for people with high blood pressure, lowering the systolic reading (the upper number) not just to 140 but all the way down to below 120 prevented cardiovascular deaths.

There was only one problem—the study hadn’t been published yet!

This week, it actually was published, in The New England Journal of Medicine, and the story now has many more caveats and concerns.

To be sure, those who got their numbers way down were less likely to have a stroke, have a heart attack or develop heart failure. Over 3.3 years, 210 people died in the “140” group, versus only 155 in the “120” group.

But the study doesn’t apply to most people with high blood pressure.

And some paid a heavy price for their cardiovascular benefits—serious adverse drug effects.

SLOWING DOWN ON THE SPRINT

Fortunately, The New York Times decided to take a more careful look this time. In an article entitled, 3 Things to Know About the Sprint Blood Pressure Trial, cardiologist Harlan Krumholz, MD, explains that the study excluded anyone with diabetes, and applied only to people over 75 or people over 50 who were already at high risk for stroke, heart disease or kidney failure. “So the results apply only to a fraction of the people already being treated for high blood pressure…,” he writes. “Of those already being treated for high blood pressure, one in six would have been eligible. What that also means is that five of six people already being treated for high blood pressure would not have fit into this study—making this evidence less relevant to them.”

Then there were the adverse effects—life-threatening episodes of low blood pressure and fainting, as well as severe kidney disease. As Dr. Krumholz interprets it, for every 100 people treated, one person had life-threatening low blood pressure, one fainted, and two more had severe kidney problems. Nor was the study long enough to let us know if there are other problems, such as dementia, that might turn up long after this approach is adopted.

In an editorial in Hypertension, cardiologist Murray Esler, MBBS, PhD, writes,  “Do we now have a new, lower therapeutic target in hypertension clinical care? …My 45 years of clinical experience in the treatment of patients with more severe grades of hypertension lead me to doubt this.”

It’s also worth noting that it took an average of 2.8 drugs per person to get blood pressure down this low. Only about half the people who tried to do it were successful. So if you fit into the narrow category of high-risk people in this study, you may want to have a conversation with your doctor about your medications. But the decision is yours. And there’s a very good chance that even if you are being treated with medication for high blood pressure, you don’t fit into that high-risk category, so this study doesn’t apply to you.

There’s no doubt that a blood pressure of 120/80 or lower is a healthy place to be. The healthiest way to get there is through diet and exercise. Even if you are already taking blood pressure medication, lifestyle changes may be enough to keep you from needing to add additional drugs to your regimen. And if you have mild high blood pressure, you may be able to avoid taking medication altogether. To learn more about nondrug approaches to high blood pressure, see Bottom Line’s Guide to Preventing and Lowering Blood Pressure—Naturally.

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Source: The New England Journal of Medicine, Hypertension and The New York Times. Date: November 12, 2015 Publication: Bottom Line Health
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