Novant Health Expert Responds to New High Blood Pressure Studies

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Recent studies are changing how doctors view treatment options for high blood pressure. Novant Health expert Dr. John Powers said this means treatment should be tailored for the individual.

“People with high risk of coronary heart disease need greater intervention to control their risk of heart attack and stroke which means picking the right blood pressure level and weighing side effects.”

New studies on managing high blood pressure are throwing into question the current guidelines held by the American Heart Association (AHA), the American College of Cardiology and the Centers for Disease Control and Prevention (CDC) and practiced by millions of health care providers.

One-third of American adults have high blood pressure, according to the AHA, with readings of 140/90 millimeters of mercury or higher. For patients with hypertension, or high blood pressure, the association recommends treatment starting with lifestyle changes and then medication to reduce readings to levels below 140/90 until age 80 and 150/90 for people older than age 80.

Dr. John Powers, a cardiologist with Novant Health Winston-Salem Cardiology, says the ideal blood pressure readings are below 140/85 for people with an elevated risk of coronary heart disease, stroke and kidney issues.

“Usually, the first line of treatment for patients involves diet, weight loss and exercise,” said Powers. “Lowering salt intake with a diet such as the DASH diet (Dietary Approach to Stop Hypertension) is effective at lowering blood pressure. Losing weight can also help people lower their blood pressure.”

However, he notes, lifestyle changes might not work for everyone to reduce blood pressure. “When patients have had three elevated blood pressure readings, it’s time to consider medication.”

High blood pressure contributed to more than 360,000 U.S. deaths in 2013, according to the CDC. The World Health Organization estimates that globally, hypertension accounts for 7.5 million deaths.

But recently released studies are challenging existing recommendations. The findings of the Systolic Blood Pressure Intervention Trial (SPRINT) support a steeper goal of reducing systolic blood pressure (top number) to 120. Such a reduction could mean that millions more Americans would take medication to manage high blood pressure.

The study found that hitting the lower 120 target reduced the risk of dying from cardiovascular causes by 43 percent. However, concern remains with pushing blood pressure below 140 among older patients who may be more sensitive to medication and subject to side effects such as dizziness, which can lead to falls.

The goal of the study was to see whether people with cardiovascular risk should have lower blood pressure targets. “The study did find a lower rate of heart attacks and coronary issues with the lower blood pressure goals, but there were other side effects were high too with greater incidence of too low blood pressure, patients passing out and kidney complications,” Powers said.

The Heart Outcomes Prevention Evaluation 3, also known as HOPE-3, raised some interesting questions as well.

Researchers found that that blood pressure medicine was effective in lowering blood pressure. However, after nearly six years of follow-up, participants with that lower blood pressure didn’t equate to a reduced risk of death from cardiovascular causes. Death from heart attack and stroke occurred in 3.5 percent of patients who received the drugs and 5 percent of patients on placebo.

The finding from HOPE-3 has experts wondering why pushing blood pressure to lower levels is not producing the benefit expected, even in individuals with a modest risk of heart attack.

Powers said that the patients in the HOPE-3 study were at lower risk than those in the SPRINT trial. Those in the HOPE-3 were all given the same medication and after treatment it was found that blood pressure risk didn’t really change at all.

“What this means for patients is that treatment of high blood pressure should be tailored for the individual,” said Powers. “People with high risk of coronary heart disease need greater intervention to control their risk of heart attack and stroke which means picking the right blood pressure level and weighing side effects.”

Powers also stated that people with diabetes already have target high blood pressure goals of 135/80, and for the elderly, it may be better to have higher systolic levels than 140.

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Jennifer Meadows
Novant Health
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