High blood pressure: are the target values too weak?
Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.
More posts by Christiane Fux All content is checked by medical journalists.Up to now, blood pressure values below 140 mmHg were considered a good target value for hypertensive patients. The current SPRINT study raises serious doubts about this. But what does that mean for the individual patient?
The report already caused a sensation in September: The study on high blood pressure therapy called SPRINT would be terminated prematurely, the scientists said at the time. According to the interim results, intensive therapy with systolic blood pressure target values below 120 mmHg saved the participants from premature death so blatantly more often than standard therapy that the other study participants could no longer be withheld from appropriate treatment. The data from the study have now been submitted to the renowned New England Journal of Medicine.
"There is a strong association between blood pressure and cardiovascular risk," said study director Paul Whelton in an interview with former president of the American Heart Association, Dan Jones. “Any antihypertensive therapy reduces the risk. The big question was: How deep do we go? ”Currently, systolic values below 140 mmHg are considered a sufficient target for high blood pressure patients.
Blood pressure below 120
There have long been indications that even less could be more. For example, observational studies on people with a low risk of cardiovascular disease show that critical cardiovascular events such as heart attack, stroke and heart failure decrease continuously up to values of 115/75 mmHG.
27 percent fewer deaths
The current SPRINT study with more than 9,000 high-risk patients now confirms the effectiveness of lower target values: Here, the number of serious cardiovascular incidents in the intensively treated group was 25 percent lower after a little more than three years than in participants whose target value was the previously propagated 140 mmHg was. In addition, 27 percent fewer died of those receiving intensive therapy during the observation period. “Those are impressive numbers,” comments Whelton. They were so convincing that the researchers wanted to go public with them now.
With three drugs to the target value
In order to achieve dream values below 120 mmHg, the participants had to take an average of 2.8 medications - one more medication than was necessary for the target values of the less intensively treated group. On average, their blood pressure was reduced from an average of 139 mmHg to 121 mmHg. "The important news for the treating physicians is that this was possible with standard drugs," says the scientist. However, side effects such as worsened kidney values were also more common. "However, the advantages of the treatment far outweigh the disadvantages," says the researcher. However, it remains to be seen whether this will remain the case with long-term therapy.
Colorful mixed group of participants
The study had patients who were at least 50 years old. 30 percent of them were even 75 years of age or older. Their systolic blood pressure was between 130 and 180 mmHg, although most of them were already taking antihypertensive drugs. They also brought with them at least one additional risk factor for cardiovascular disease - for example, they smoked or were overweight. Excluded from the study were people with kidney disease, who had already suffered a heart attack, whose blood pressure was particularly difficult to control - and diabetics.
Questionable advantage for diabetics
For the latter, the much acclaimed ACCORD study had already delivered a different result: For diabetics with high blood pressure, no advantage of values below 120 mmHg compared to values between 120 and 140 mmHg was found. On the basis of this investigation, too, the target blood pressure values were subsequently loosened to a large extent. "However, the SPRINT study is statistically superior to the ACCORD study," write Vlado Perkovic and Anthony Rodgers from The George Institute for Global Health in Sydney in a comment on the study.
Massive lowering of blood pressure for everyone?
Back to the SPRINT study: what does this mean for the individual? Strictly speaking, the study only provides treatment advice for exactly those types of patients that correspond to those in the study - for example, an 80-year-old who has values of 130 mmHg. "If he doesn't experience any side effects from the medication, it might be right to lower his blood pressure even further," says Whelton. The situation is different for a 30-year-old with a value of 136 mmHg, who carries a familial increased risk of cardiovascular diseases and diabetes. Lower values could also be useful for him. "Strictly speaking, the study cannot clarify that," says the researcher.
Either way: the investigation will not remain without repercussions. “Time to rethink blood pressure goals,” headlined cardiologist and former President of the University of Boston Aram V. Chobanian in another comment. A possible consequence could be an adjustment of the intentional guidelines.
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