Intensive therapies to reduce high blood pressure can cut the risk of heart disease in older adults without increasing the risk for falls, according to doctors at Wake Forest Baptist Medical Center.
In the United States, 75 percent of people over age 75 have hypertension, which can lead to cardiovascular disease, a leading cause of disability, morbidity and death. Current guidelines have provided inconsistent recommendations regarding the optimal systolic blood pressure (SBP) treatment target in geriatric populations.
The latest findings from the National Institutes of Health’s Systolic Blood Pressure Intervention Trial (SPRINT) are published in the May 19, 2016 issue of the Journal of the American Medical Association.
The study, which focused on ambulatory adults 75 or older, showed that adjusting the amount or type of blood pressure medication to achieve a target systolic pressure of 120 millimeters of mercury (mm Hg) reduced rates of cardiovascular events — heart attack, heart failure and stroke — by almost a third and the risk of death by almost a quarter, as compared to a target systolic pressure of 140 mm Hg. “Some of the most vulnerable ambulatory people in the community who may suffer complications of high blood pressure can benefit from intensive blood pressure lowering and it is safe to do so,” said Jeff Williamson, M.D., professor of gerontology and geriatric medicine at Wake Forest Baptist and lead author of the study.
“If you look at elderly people who are hospitalized in the year that they become disabled and have to leave their home, about half the time those diagnoses or hospitalizations result from complications of hypertension, like heart failure, stroke and heart attack.” In this study, the 2,636 participants were randomized to an intensive target systolic blood pressure (SBP) treatment target of 120mmHg or the standard target of SBP of 140 mmHg. People with diabetes or heart failure were not included in the trial.
At the beginning of the study, people underwent blood pressure measurement three times in a quiet room, completed a walking test to determine gait speed, and responded to a questionnaire to categorize their level of frailty. Blood pressure was rechecked every three months and medication adjusted as needed.
Both groups also were checked for eight potential complications of lower blood pressure, such as hospitalizations, falls, acute kidney injury and fainting. The researchers found no difference between the two groups in these areas. On average, persons in the lower blood pressure goal group required one additional medication to reach goal.
“These findings have substantial implications for the future of high blood pressure therapy in older adults because of its high prevalence in this age group, and because of the devastating consequences high blood pressure complications can have on the independent function of older people,” Williamson said.
“Most of the medications used in SPRINT were generic, so this is a fairly inexpensive way to help prolong the time that people can live independently in their homes and avoid those common conditions that often cause a person to have to move to higher level of care or an institution.”
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- Jeff D. Williamson, Mark A. Supiano, William B. Applegate, Dan R. Berlowitz, Ruth C. Campbell, Glenn M. Chertow, Larry J. Fine, William E. Haley, Amret T. Hawfield, Joachim H. Ix, Dalane W. Kitzman, John B. Kostis, Marie A. Krousel-Wood, Lenore J. Launer, Suzanne Oparil, Carlos J. Rodriguez, Christianne L. Roumie, Ronald I. Shorr, Kaycee M. Sink, Virginia G. Wadley, Paul K. Whelton, Jeffrey Whittle, Nancy F. Woolard, Jackson T. Wright, Nicholas M. Pajewski. Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years. JAMA, 2016; DOI: 10.1001/jama.2016.7050