Wednesday, February 1, 2017


Paper will appear in Circulation, and an advance copy can be found – here.

Researchers have projected that aggressively lowering blood pressure could help prevent more than 100,000 deaths each year.

“The public health impact of adopting intensive treatment in the right patients is enormous,” said Adam Bress, University of Utah assistant professor of population health sciences.

Bress and his fellow experts from institutions across the country built upon the landmark Systolic Blood Pressure Intervention Trial, which found that decreasing blood pressure to less than 120 mmHg compared to 140 mmHg reduced heart attack, stroke and death in people that were at high risk. But -- until now -- the potential number of lives that could be saved by the 2015 SPRINT results if fully implemented was unknown.

The University of Utah-led team of researchers used data from the National Health and Nutrition Examination Survey from 1999 to 2006 conducted by the National Center for Health Statistics. Using the science of survey design, they focused on about 2,000 men and women who met the SPRINT eligibility criteria to determine the projected 107,500 lives saved each year.

The leading cause of death in the U.S. is heart disease. In past decades, doctors had typically worked to keep patients’ blood pressure less than 140 mmHg. SPRINT concluded that there could be a 27 percent reduction in mortality through the intensive blood pressure regimen.

Most Americans will experience high blood pressure at some point in their lives.

“The lifetime risk of high blood pressure in the US is about 80 percent,” said Richard Cooper, professor and chairman of Public Health Sciences at Loyola University Medical School, who collaborated with Bress. “Optimal management is one of the most significant contributions of medical care to patient survival. So we need to understand that small improvements in individual management can make a major impact on people’s health.”

To achieve blood pressure of 120 or less, it’s likely people would need to take three or four medications instead of two recommended for the higher rate, the assistant professor said. They would likely also see the doctor more frequently and need more lab tests. Though this would require some additional spending, the overall cost of high blood pressure in the U.S. is large.

“Currently about 80 million Americans have higher blood pressure: 1 out of 3,” Bress said. “And the treatment cost of hypertension is about $80 billion a year.”

The drugs doctors would need are already available, safe, effective, and inexpensive, he added.

Bress is the lead author of “Potential Deaths Averted from SPRINT Implementation,” which was published in the most recent issue of “Circulation.”

He acknowledges some concerns remain about dropping blood pressure so dramatically. One unknown is the impact on cognitive function. Further research related to SPRINT is underway to answer that question now. Additional blood pressure medications could cause potassium and sodium levels to fluctuate. And blood pressure that is too low could cause an individual to faint.

 “The point we’re trying to make when it comes to choices around intensive treatment is:  would you be willing to reduce your risk of stroke or early death while incurring a small increase in the risk of a fall?” said Bress.

Cooper believes the treatment goal for systolic blood pressure should be reset to at least 130. Practical trials should be created to help monitor blood pressure at home and find systems -- such as electronic recording -- that make it easier for doctors to meet that target, he said.

Additional research is underway to decipher who may best benefit from SPRINT protocol -- whether that is someone who is of a certain age group, does not have diabetes or other conditions.

Bress and the researchers crunched their data on individuals who met SPRINT eligibility: 50 or older, at high risk of cardiovascular disease and without a history of diabetes or stroke.

How to implement the reduced blood pressure protocol and how to study its result also remains a question mark, Bress said. But he doesn’t think there should be a delay.

“If it takes 10 years to implement, we could have prevented a lot more deaths,” he said.


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