Dropping blood pressure to 120 lowers heart woes, data confirm

SPRINT study results support new, lower target, but also reveal risks of aggressive treatment

UNDER PRESSURE Hitting a systolic blood pressure target of 120 millimeters of mercury took, on average, three drugs for a group of participants undergoing intensive treatment (orange line) in an NIH-sponsored clinical trial. To meet a target of 140, another group of participants (blue line) required, on average, two drugs.

fotohunter/Shutterstock; graph: J.T. Wright et al/NEJM 2015

By Meghan Rosen

November 9, 2015 at 3:16 pm

Aggressive treatment for high blood pressure saves lives, newly released data from a recently halted clinical trial suggests.

Using drugs to lower systolic blood pressure to less than 120 millimeters of mercury cut people’s risk of heart attacks and other cardiovascular woes by 25 percent, researchers report November 9 in the New England Journal of Medicine. That’s compared with treatments that aim to drop blood pressure to below 140.

Earlier this year, preliminary results from the trial, named the Systolic Blood Pressure Intervention Trial, or SPRINT, convinced the National Institutes of Health to end the study a year ahead of schedule (SN Online: 9/11/15). At the time, the National Heart, Lung, and Blood Institute called SPRINT a “landmark” study that “provides potentially lifesaving information.” But some scientists worried that the release contained no data about the trial, had not been peer-reviewed and did not mention the risks of intensive treatment to lower blood pressure (SN: 10/17/15, p. 6).

The study followed 9,361 people aged 50 or older with high blood pressure and who were at risk for cardiovascular disease. Serious medical consequences, including low blood pressure, kidney failure and loss of consciousness, were slightly more common in the 120-target group than in the 140-target group, the new data show. Overall, the benefits of aggressive blood pressure treatment were significant, but small. In the 120 group, 1.65 percent of participants experienced serious cardiovascular problems compared with 2.19 percent in the 140 group.

“The results are quite clear,” says cardiologist Sripal Bangalore of New York University Langone Medical Center. “You can’t argue against the benefits” of aggressive treatment, he says. “But there is a price to pay.”

And even minor side effects can convince patients to stop taking their medication, he says. What’s more, less than half of the participants in the 120 group were even able to meet their target. In a clinical setting, without the carefully controlled monitoring of a trial, it may be “much, much harder” for patients to hit a low blood pressure goal, he says.