Is a blood pressure less than 120/80mm Hg healthier than a higher blood pressure? Scientists randomly assigned 9,361 subjects with systolic blood pressure of 130 mm Hg or higher and increased cardiovascular risk, but without diabetes, to two groups. The intensive treatment group had a systolic blood-pressure target of less than 120 mm Hg while the standard treatment group had a systolic blood pressure target of less than 140mm Hg. This study is known as the SPRINT trial. The end point of the study was the difference in cardiovascular endpoints—heart attacks, stroke, heart failure or death from cardiovascular causes.
The study was stopped early at 3.26 years due to a 27% lowered all-cause mortality rate in the intensively treated group. Furthermore, there was a 25% lowered rate of the primary composite outcome—which is measured by averaging all the cardiovascular outcomes. (New England Journal of Medicine. November 9, 2015)
When this study was released, the media released headlines that proclaimed that a lowered blood pressure is better than a higher blood pressure. The New York Times headline stated, “Lower Blood Pressure Guidelines Could Be ‘Lifesaving,’ Federal Study Says.”
Nobody knows what the optimal blood pressure values should be. I can assure you there is not one number that is optimal for everyone at every age. When I was in medical school, I was taught that normal blood pressure rises with age. This is still true. As we age, our arteries become stiffer therefore, we require a higher blood pressure to pump blood to the entire body. It is ludicrous to believe that an 80-year-old should have the same blood pressure as a 20-year-old. Setting blood pressure guidelines for everyone at 120 mm Hg or less guarantees that nearly every adult over the age of 40 will require a blood pressure medication in order to meet these guidelines.
What was not reported in the media was that the rate of serious adverse events including hypotension, syncope (fainting), electrolyte abnormalities and kidney failure were all significantly higher in the intensive versus the standard-treatment group. Each of these adverse events are well-known to occur when too many antihypertensive medications are prescribed and the blood pressure is lowered too much.
Furthermore, what was not reported in the media was the absolute risk difference between the two groups. The media reported the less-accurate relative risk difference—25% reduction in the primary cardiovascular endpoints and a 27% reduction in all-cause mortality. The more-clinically relevant absolute risk difference between the two groups was 1.6% in the primary outcome and 1.2% in the all-cause mortality. Therefore, in order to prevent any cardiovascular endpoint (stroke, heart attack, heart failure, death, etc,) you would need to treat 62 patients for 3.26 years to prevent one event. That means, the treatment group failed 98% (61 out of 62). Similarly, for all-cause mortality, you would need to treat 83 patients for the same time period to prevent one mortality. In this case, the treatment failed 99% since 82 out of 83 subjects received no benefit.
Finally, the difference between the intensive and the standard treatment group for all the primary outcomes was 0.54% per year. That means that if you are in the intensive treatment group, you will have a reduced chance of having a primary outcome (heart attack, stroke, death, etc.,) for 2 days for each year you take the antihypertensive drugs . So, if you take blood pressure medications for 30 years in order to lower your blood pressure below 120 mm Hg you will receive a primary outcome benefit of 60 days. When you factor in the serious adverse effects (mentioned above) of maintaining a very low pressure, I say fugetaboutit. This study is another example of the Powers-That-Be trying to scare us into taking more unnecessary drugs.
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