Intensive therapies to reduce high blood
pressure can cut the risk of heart disease in older adults without increasing
the risk for falls, according to doctors at Wake Forest Baptist Medical Center.
In the United States, 75 percent of people over age 75
have hypertension, which can lead to cardiovascular disease, a leading cause of
disability, morbidity and death. Current guidelines have provided inconsistent
recommendations regarding the optimal systolic blood pressure (SBP) treatment
target in geriatric populations.
The latest findings from the National Institutes of
Health’s Systolic Blood Pressure Intervention Trial (SPRINT) are published in
the June 28 issue of the Journal of the American Medical Association.
The study, which focused on ambulatory adults 75 or
older, showed that adjusting the
amount or type of blood pressure medication to achieve a target
systolic pressure of 120 millimeters of mercury (mm Hg) reduced rates of
cardiovascular events -- heart attack, heart failure and stroke -- by almost a
third and the risk of death by almost a quarter, as compared to a target
systolic pressure of 140 mm Hg.
“Some of the most vulnerable
ambulatory people in the community who may suffer complications of high blood
pressure can benefit from intensive blood pressure lowering and it is safe to
do so,” said
Jeff Williamson, M.D., professor of gerontology and geriatric medicine at Wake
Forest Baptist and lead author of the study.
“If you look at elderly people who are hospitalized in
the year that they become disabled and have to leave their home, about half the
time those diagnoses or hospitalizations result from complications of
hypertension, like heart failure, stroke and heart attack.”
In this study, the 2,636 participants were randomized to
an intensive target systolic blood pressure (SBP) treatment target of 120mmHg
or the standard target of SBP of 140 mmHg. People with diabetes or heart
failure were not included in the trial.
At the beginning of the study, people underwent blood
pressure measurement three times in a quiet room, completed a walking test to
determine gait speed, and responded to a questionnaire to categorize their
level of frailty. Blood pressure was rechecked every three months and
medication adjusted as needed.
Both groups also were checked for eight potential complications
of lower blood pressure, such as hospitalizations, falls, acute kidney injury
and fainting. The researchers found no difference between the two groups in
these areas. On average, persons in the
lower blood pressure goal group required one additional medication to reach
“These findings have substantial implications for the
future of high blood pressure therapy in older adults because of its high
prevalence in this age group, and because of the devastating consequences high
blood pressure complications can have on the independent function of older
people,” Williamson said.
“Most of the medications used in SPRINT were generic, so
this is a fairly inexpensive way to help prolong the time that people can live
independently in their homes and avoid those common conditions that often cause
a person to have to move to higher level of care or an institution.”
Co-authors include: William B. Applegate, M.D.,
Amret T. Hawfield, M.D., Dalane W. Kitzman, M.D., Carlos J. Rodriguez, M.D., Kaycee
M. Sink, M.D., Nancy F. Woolard, and Nicholas M. Pajewski, Ph.D., of Wake
Forest Baptist; Dan R. Berlowitz, M.D., of Boston University; Mark A. Supiano,
M.D., of University of Utah; Ruth C. Campbell, M.D., of Medical University of
South Carolina; Glenn M. Chertow, M.D., of Stanford University School of
Medicine; Larry J. Fine, M.D., of
National Heart, Lung and Blood Institute; William E. Haley, M.D., of Mayo
Clinic; Joachim H. Ix, M.D., of University
of California San Diego; John B. Kostis, M.D., Rutgers Robert Wood Johnson
Medical School; Marie A. Krousel-Wood, M.D., Paul K. Whelton, M.D., of Tulane
University School of Medicine; Lenore
J. Launer, Ph.D., of National Institute on Aging; Suzanne Oparil, M.D., Virginia
G. Wadley, Ph.D., of University of Alabama at Birmingham; Christianne L.
Roumie, M.D., of Vanderbilt University; Ronald I. Shorr, M.D., of University of
Florida; Jeffrey Whittle, M.D., of Medical College of Wisconsin; and Jackson T.
Wright Jr., M.D., Ph.D., of Case Western Reserve University.
Funding was provided by the National
Institutes of Health, including the National
Heart, Lung, and
Blood Institute (NHLBI), the National Institute of Diabetes and Digestive and Kidney
Diseases (NIDDK), the National Institute on Aging
(NIA), and the National Institute
Disorders and Stroke (NINDS), under Contract
Numbers HHSN268200900040C, HHSN268200900046C, HHSN268200900047C,
HHSN268200900048C, HHSN268200900049C, and Inter-Agency Agreement Number A-HL-13-002-001.
It was also supported in part with resources and use of facilities through the
Department of Veterans Affairs.
Additional funding was
provided by the
Wake Forest Claude Pepper Older Americans Independence Center (P30-AG21332),
R01-HL10741 (MAS), and the following CTSAs funded by NCATS: CWRU:
UL1TR000439, OSU: UL1RR025755, U Penn: UL1RR024134& UL1TR000003, Boston: UL1RR025771,
Stanford: UL1TR000093, Tufts: UL1RR025752, UL1TR000073 & UL1TR001064,
University of Illinois: UL1TR000050,
University of Pittsburgh: UL1TR000005,
UT Southwestern: 9U54TR000017-06,
University of Utah: UL1TR000105-05,
Vanderbilt University: UL1 TR000445, George Washington University: UL1TR000075, University of CA, Davis: UL1 TR000002, University of Florida: UL1 TR000064, University of Michigan: UL1TR000433, Tulane University: P30GM103337 COBRE Award NIGMS.