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6 Questions About Blood Pressure: A recent trial recommends a lower blood pressure target to reduce the risk of heart attacks and strokes. A stroke expert interprets the results.

Hiscott, Rebecca

doi: 10.1097/01.NNN.0000480820.78662.ce
Departments: The Waiting Room

Ask Your Doctor: Important questions about lower blood pressure recommendations.

For years, the American Heart Association has recommended a target systolic blood pressure of less than 140 to maintain good cardiovascular health. That number has guided health care professionals for decades. But a new study published in the New England Journal of Medicine in November 2015 suggests that a lower target of 120 may be appropriate.

We spoke to stroke specialist Mitchell S. V. Elkind, MD, FAAN, a professor of neurology and epidemiology at Columbia University Medical Center, who was not involved in the trial, to learn more.

What were the parameters of the study?

The Systolic Blood Pressure Intervention Trial, or SPRINT, as it's called, involved 9,361 people aged 50 or older with a systolic blood pressure of 130 to 180 without medication; at least one risk factor for heart disease, such as smoking or high cholesterol; and no history of diabetes or stroke. Half of the patients worked with their doctors to reach a blood pressure of 140 or lower, while the other half aimed for a target of 120 using common blood pressure medications.

The study was stopped early. Why?

After almost four years of follow-up, the 120 blood pressure group had much better outcomes, with a 25 percent lower risk of heart attack, stroke, heart failure, acute coronary syndromes like angina, and death from cardiovascular causes.

Is this new blood pressure target appropriate for everyone?

If, like the patients in the trial, you're at least 50 years old with high blood pressure and no history of stroke or diabetes, you might want to discuss a more intensive blood pressure management regimen with your doctor. If you fit only some of the criteria, however—for example, you're over age 50 and have high blood pressure but also have diabetes—your doctor will need to make a judgment call based on other factors. (For elderly people at risk for dementia, this blood pressure target may be too low. See “Pressure Drop”)

Were more drugs used to reach 120?

On average, participants in the intensive treatment group took one more drug than those in the standard treatment group—2.8 medications compared with 1.8. That means some people could be taking four or even five medications to get their blood pressure down. The number of drugs needed to reach the lower number varies from person to person, so be sure to discuss this with your doctor.

What are the risks of taking more drugs?

Your blood pressure could drop too low, which can lead to dizziness and fainting, particularly among the elderly. In the SPRINT trial, people aiming for the lower number had a higher risk of side effects like fainting and decreased kidney function. For those who have had fainting spells or who are at risk of kidney problems, the potential dangers may outweigh the benefits.

Are there other ways to lower blood pressure?

Physical activity and weight loss can reduce blood pressure. Other lifestyle changes, such as cutting back on processed foods, eating more fruits, vegetables, and fish, and limiting carbohydrates and alcohol can also help. Try to exercise for at least 30 minutes five times a week, and push yourself hard enough to get the heart pumping.

© 2016 American Academy of Neurology