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Study adds to confusion over blood pressure guidelines

The two latest major studies, including one released last week in the New England Journal of Medicine, add confusion and a dose of conflict to hypertension treatment guidelines. The U.S. is ranked number one in the world for medical research and development, spending just under $500 billion annually. You’d think the industry advising doctors could settle on a recommended blood pressure (BP) guideline but recently studies have created more disparity than consensus, according to an NPR article published today.
There is little or no disagreement that lifestyle affects one’s blood pressure as does heredity. Similarly, we know that high blood pressure puts us at greater risk of heart disease, stroke and kidney disease. There is also a steadfast consensus that a healthy diet and moderate exercise helps to control weight and reduces the likeliness of developing high blood pressure. One more point about medical consensus: a systolic (top number) BP of 140-plus is when doctors routinely prescribe BP medication(s) for patients younger than 60.
However, in the last couple of years, studies conducted to determine ideal BP recommendations have instead complicated decision-making for doctors. For example, the SPRINT trial released last November suggested that even older people who are not diabetic should maintain a systolic BP of 120. Unfortunately, after 60 or 70 years, age-related sclerosis (hardening or thickening of artery walls) pushes BP numbers up on average. Because older people are often more sensitive to the side effects of BP medicines, the SPRINT research was deemed by many to suggest unrealistic and unnecessarily stringent treatments for many patients, particularly older people.
In April, a new study called HOPE–3 contradicted the SPRINT findings, adding to the confusion over the ideal BP profile. The HOPE-3 research included 12,705 randomized participants known to have at least one cardiovascular risk factor (like high cholesterol) who received either blood pressure medication or a placebo and six years of follow-up examinations. At randomization, the average systolic blood pressure of the group was 138 but included participants with higher and lower pressures. About 33% began the study with their top number less than 132. As expected, blood pressures dropped an average of six points in participants taking real blood pressure medication. However, quite unexpectedly, lowering their blood pressure did not benefit them when compared to the group taking a placebo. Researchers determined that lowering blood pressure did not translate into lower risks of death from typical cardiovascular causes. Basically, heart attacks, strokes, and related medical maladies occurred at strikingly similar rates in both groups.
Interestingly, the top third of participants who were ranked as having the highest BP at the start (an average top number of 154) incurred less cardiovascular issues, while participants in the lowest third at the start (average of 122) appeared to do worse. The six-year follow-up analysis was built into the study from the start which researchers say adds credibility to the results.
The HOPE-3 researchers used common antihypertensive medications, an angiotensin receptor blocker called candesartan and a diuretic called hydrochlorothiazide. The average age of participants was 65, approximately split between male and female, another 25 percent were smokers and almost all were overweight. Conventional knowledge would suggest a benefit in lowering the blood pressure of patients with such profiles, but the HOPE-3 study showed no improvement in risk factors at all for patients who received actual medications for blood pressure.
Meanwhile, the medical industry is losing not gaining consensus on what constitutes an ideal systolic BP, particularly in patients 60 and older. The disparity compounds when doctors attempt to reduce a 70-year-old patient’s systolic pressure from 150 to 120 since medications that drop BP by 30 points could have negative consequences for frail, elderly patients.

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