US heart groups to weigh new data for hypertension treatment guidelines
ORLANDO, Florida: US heart organizations drafting new treatment guidelines for hypertension will consider new research showing that aggressively lowering blood pressure can ward off death and other cardiac problems, but top cardiologists advised caution in how the information is applied to wide practice.
Once called the “silent killer,” high blood pressure can be brought under control with a wide array of medications, many sold as relatively inexpensive generics. About 70 million people in the United States live with hypertension. The medical community has been divided over whether there is an optimal blood pressure level for such patients. A government-sponsored study of more than 9,300 hypertension patients ages 50 and older showed that death from heartrelated causes fell 43 percent and heart failure rates dropped 38 percent when their systolic blood pressure was lowered below 120 versus those taken to a commonly used target of under 140.
The findings of the Sprint study, released on Monday at the American Heart Association annual meeting in Orlando, Florida, will figure into new hypertension guidelines being drafted by the AHA and the American College of Cardiology. Their work is expected to be completed next year.
“The writing panel will review and consider all available evidence, including the Sprint trial presented this week,” AHA and ACC said in a joint statement to Reuters.
The Sprint study findings could prove to be a turning point in the medical community’s approach to high blood pressure. The US government’s National Institutes of Health stopped the planned five-year study in August, two years early, after independent monitors found such clear benefits that it felt a need to make them public. Dr. Mariell Jessup of the University of Pennsylvania Medical Center, who chairs a panel helping to draft the guidelines, said she was happy to have the new evidence because it can be difficult to convince patients to take more medicines to prevent future problems.
“It’s really nice to be able to say, ‘This trial showed that this is where you need to be, because you’re going to live longer.’ That’s meaningful,” Jessup said.
Other cardiologists said the risks of more aggressive treatment need to be explored more rigorously before applying it widely. Patients in the 120 systolic blood pressure group, for example, had a higher rate of kidney injury or failure, as well as fainting, although there was no increase in injuries from falls. Dr. Steven Nissen, the Cleveland Clinic’s chief of cardiology, said he would want to know which patients were likely to suffer kidney failure before changing his practice.
“The thing that makes me pay attention is the one improvement that is the most important one, and that is death,” Nissen said. “It’s a big effect. The mortality advantage is compelling.”
The two medical groups would not say whether they will recommend specific blood pressure targets for various patient populations. They spurred controversy among cardiologists two years ago with new cholesterol treatment guidelines that eliminated a target level for “bad” LDL cholesterol in favor of a more complicated method of assessing a patient’s individual risk for heart disease. —Reuters