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 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 goal.
“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 of Neurological 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.