LTC BULLETIN BOARD
Study Suggests Even Lower Blood Pressure for Older Adults
Annals of Long-Term Care: Clinical Care and Aging. 2016;24(2):40.
A recent hypertension study published in The New England Journal of Medicine, known as SPRINT (Systolic Blood Pressure Intervention Trial), suggests that a target blood pressure level much lower than what is currently recommended can significantly cut the risk of heart failure and death from heart problems. Although the study results were dramatic, the means to attaining lower blood pressure levels may be too risky for older adults, an article in Consumer Reports suggests.
Under current guidelines, the ideal is a systolic pressure of 120 mmHg or less and a diastolic pressure of 80 mmHg or less. Patients are considered to have high blood pressure if systolic pressure is >140 mmHg or diastolic pressure is >90 mmHg. But experts have long debated whether those with high blood pressure need to get their levels all the way down to the ideal level or whether levels below the cutoff for high blood pressure are equally beneficial.
The government-funded trial involved more than 9300 people over the age of 50 years with elevated blood pressure and a high risk of heart attack. Participants were given medication to reduce their blood pressure, with about half aiming to lower their systolic pressure to 120 mmHg and the other half aiming for 140 mmHg.
The study was slated to run for 5 years but was stopped after slightly more than 3 years because results were so dramatic. During that time, 65 participants with a goal systolic pressure of 140 mmHg died, and 100 developed heart failure. Of participants with a goal systolic pressure of 120 mmHg, only 37 died and 62 developed heart failure.
However, to get their systolic pressure down to 120 mmHg, people had to take an average of three blood pressure medications, leading to almost double the instances of serious side effects, including some that required emergency care at a hospital, such as kidney failure, dangerously low blood pressure, and imbalances in potassium or sodium blood levels.
Many people already find it difficult to take their blood pressure medication consistently, and an additional pill may increase that challenge, noted Michael Pignone, MD, University of North Carolina School of Medicine, Chapel Hill. In fact, because of side effects, the need to cut costs, and/or other factors, up to one-half of people stop taking their high blood pressure medication within 1 year. “Putting somebody on more medications if they’re not consistently taking their current regimen is not a helpful strategy,” said Dr Pignone. —Amanda Del Signore