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 In adults above age 75 who could walk without assistance, keeping
the top blood pressure number below 120 millimeters of mercury
(mmHg) led to significantly lower rates of cardiovascular events and
deaths from any cause, the study found.
There had been some fear that bringing the top number - called the
systolic pressure - down below 120 mmHg might actually be risky for
older individuals. If their blood pressure were too low, they'd be
vulnerable to falls and other problems.
“We can reassure patients, especially from this study, that lowering
blood pressure is safe. There were no more serious adverse events or
falls among people on intensive blood pressure control versus those
on standard control,” Dr. Jeff D. Williamson, of the Sticht Center
on Aging at Wake Forest School of Medicine in Winston-Salem, North
Carolina, told Reuters Health in a phone interview.
“This is really important news because there’s been a lot of news
(about studies) using administrative databases and self report that
has indicated to older people that it’s dangerous to treat blood
pressure; you might fall more. This is the most rigorous scientific
study to ever look at that and it shows that that’s really not true.
That’s actually been found the case in other blood pressure studies
but not to this level of detail,” Williamson said.
Williamson and colleagues analyzed data on 2,636 participants with
high blood pressure in the Systolic Blood Pressure Intervention
Trial who were 75 or older.
The systolic blood pressure reflects the pressure in the vessels as
the heart contracts to push blood out to the body.
Overall, 1,317 patients had been randomly assigned to have their
systolic blood pressure brought down with medication until it was
120 mmHg. In another 1,319, doctors tried to achieve a target
systolic blood pressure of 140 mmHg.
As reported in the Journal of the American Medical Association, over
the next three years, on average, the group with the lower blood
pressure target had significantly fewer cardiovascular events and
fewer deaths.
The rate of serious adverse events did not differ between the
treatment groups.
The study had a fairly representative sample of older people who
would typically come to their doctor’s office, not living in a
nursing home or assisted living, Williamson said. The results apply
“to a broad spectrum of people, and it only required one additional
medication on average to achieve this result. It’s relatively
practical, 90 percent of the medications used were generic,” he
said.
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“There’s so much hypertension in older people we almost begin to see
it as normal. It can lull us to think this is not practical,” he
added. “The study shows that a lot of people are eligible to have
better blood pressure.”
“This study very carefully measured blood pressure and did it three
times in the office without the doctor present to avoid white coat
hypertension, but also to avoid what often happens in a doctor’s
office: the patient runs in from the parking lot flustered to take
the blood pressure and it might be high,” Williamson explained.
“Health systems will need to make more accommodation for more
accurate assessment of patients, especially in the area of blood
pressure. It’s very important now to begin to look at how electronic
medical records and value-based care models can incentivize the
health care system to implement this,” he concluded.
In an editorial, Dr. Aram V. Chobanian of Boston University School
of Medicine wrote that bringing systolic blood pressure down below
130 mmHg in older patients "may be challenging for clinicians,
because doing so could require use of additional medications, more
careful monitoring, and more frequent clinic visits.”
“Nevertheless,” he concluded, “the important results reported by
Williamson et al in this issue of JAMA cannot be discounted, and
unless unexpected adverse effects are observed on further
examination of the trial data, then major changes in treatment goals
for patients 75 years or older with hypertension will be warranted."
SOURCE: http://bit.ly/1WEPaz3 and http://bit.ly/1TzIaxd The Journal
of the American Medical Association, online May 19, 2016.
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