US heart groups to weigh new data for hy­per­ten­sion treat­ment guide­lines

Kuwait Times - - HEALTH -

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

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