Seniors with Hypertension Should Aim for Lower Blood Pressure than the Commonly Recommended Level

One of the major public health issues is hypertension, which is high blood pressure. One in every three American adults, and three in every four in the above- 75- age- group are affected by it. Although it produces no symptoms, it is a main risk factor for serious health issues including cognitive function decline, chronic kidney disease, heart failure, and heart attack.

Blood pressure is represented by two numbers such as 120/80 millimeters of mercury (mm Hg). The number written first is systolic pressure, which is measured when your heart beats to pump blood; and the number written next is diastolic pressure, which is measured between the beats, when the heart is at rest.

Several components of the NIH such as the NHLBI (National Heart, Lung, and Blood Institute) sponsored a research to test the targeted blood pressure for patients with high blood pressure, but without diabetes. In their Systolic Blood Pressure Intervention Trial (SPRINT), they made comparisons between a less than 120 mm Hg (intensive treatment) target systolic blood pressure and a 140 mm Hg (standard treatment) in over 9,300 participants, of 50 years of age and older. The SPRINT results showed that after an average follow-up of some 3 years, those participants who were treated at the lower target blood pressure level had a lower risk of cardiovascular disease and death.

The study’s most recent analysis was headed by Dr. Jeff Williamson at Wake Forest Baptist Medical Center. It focused on a subgroup of over 2,600 SPRINT participants who were 75 years of age and older. The researchers randomly assigned these participants to either the standard or intensive treatment goals (140 mm Hg or 120 mm Hg). They found the very same result with this subgroup as well when they were followed up for 3.14 years. That is, those participants who were treated at the lower target blood pressure level had a lower risk of strokes, heart failure, and heart attacks. The report of this study was published online in the Journal of the American Medical Association on May 19, 2016.

The seniors in the intensive treatment group had achieved a mean systolic blood pressure of 123 mm Hg, while that achieved by those in the standard treatment group was 135 mm Hg. To reach their lower goal, those participants in the intensive treatment group required about one more drug.
Only 2.6% of participants in the intensive treatment group per year, that is, 102 of them, had cardiovascular events. This is significantly lower than the 3.8% of participants per year in the standard treatment group, which is 148 of them. The lower blood pressure group participants also had lower risk of death. In the former group, the death percentage was 1.8% (73 deaths) per year whereas in the latter group, it was 2.6% (107 deaths) per year.

Each of the participants’ frailty index was measured for 37 components; and it was found that the benefits held true for both frail and non-frail participants.

The gross rate of serious adverse events in older people did not vary between the two treatment groups. However, there was slightly higher levels of some events, like acute kidney injury, fainting, and low blood pressure in the intensive treatment group. At this level of follow-up, the advantages certainly outweigh the above mentioned risks, but longer term follow-up is necessary to study these issues further.

Since high blood pressure complications are common in seniors, the finding that seniors aiming for a lower blood pressure target experience reduced risk of cardiovascular disease and death, would help doctors make more informed decisions regarding blood pressure goals, says Williamson. Those hypertension patients who would like to know whether a lower goal is right for their situation, should consult their doctor in this regard.

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