Study: Lower targets for blood pressure can prevent heart attacks and strokes

For patients over 50, having blood pressure below the commonly recommended targets can drastically reduce the risk of heart disease and strokes. That’s according to a major blood pressure study from the National Institutes of Health, which called the information "potentially lifesaving." Hari Sreenivasan speaks to Dr. Gary Gibbons of the National Heart, Lung and Blood Institute.

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    There's news out from the National Institutes of Health today that could change the way we deal with blood pressure. Researchers found that, for many patients over 50, blood pressure far below the commonly recommended targets can drastically reduce the risk of heart attacks, strokes and deaths.

    Doctors said the top line of a blood pressure reading should be below 120 for many. Prior recommendations put the number at 140. In fact, the NIH announced the end of a major blood pressure study a year early, saying it was potentially lifesaving information.

    Dr. Gary Gibbons is director of the National Heart, Lung and Blood Institute at NIH, which sponsored the trial. He joins us now.

    Dr. Gibbons, first of all, break this down for us. Why is this significant?

    DR. GARY GIBBONS, National Heart, Lung and Blood Institute: Well, as you know, Hari, 70 million Americans have high blood pressure.

    It predisposes to the leading causes of death, such as heart disease and stroke. And we knew for a long time that treating high blood pressure was important to prevent these complications. But there was a lot of uncertainty as to how low doctors should go and bringing that pressure down.

    The SPRINT study, Systolic Blood Pressure Intervention Trial, was designed to ask and answer that question. And now we have those interim results that make it very clear that being aggressive and intensive treatment regimen that goes to that lower target below 120 millimeters of mercury shows great benefit in reducing the complications such as heart attacks, heart failure and stroke and saves lives.


    When you start to say low blood pressure, people are going to start becoming concerned about the elderly, for whom low blood pressure can lead to dizziness or fainting. How do you figure out if 120 is right for you?


    Well, as in all things, that we must balance the benefits against potential harms. And that's why it's important for each patient to consult their care provider to see what's the right target for them.

    But it's important to note that this study included individuals 50 and over, and indeed included — one-fourth of the study sample with age 75 or older. So it was inclusive of the elderly. Indeed, our preliminary analyses suggest that the benefit, we're seeing across the diverse group of people in the study sample, including those over 75.

    So, we think that this may be broadly applicable to those 50 and older who are at increased risk of cardiovascular disease.


    Just a couple of years ago, it seemed that the guidelines went in the opposite direction, taking the number from 140 up to 150, and now we're bringing it back down again. What is to say in a couple of years this number or this target doesn't change?


    Well, as you point out, there was some element of debate about what the right target should be.

    And, indeed, it's because of that uncertainty that trials like SPRINT were so important to conduct. And, indeed, now that we have the data, now we have more definitive evidence, this brings clarity to — within that fog of uncertainty.

    We look forward to the publication of the full results. And we anticipate it will inform those organizations that develop clinical practice guidelines that should provide patients and their care providers with much clearer guidance about what the right target is. And we're confident that the definitiveness of this study will provide that clarity.


    Finally, a lot of this in your studies was brought down by medications. But if you add more drugs to the mix, don't they have perhaps side effects that counter what you're doing?


    Well, as you point out, it's very important, as clinicians routinely do, to again recognize the benefits and potential side effects.

    It's important to recognize that what this study showed is that there was a combination of therapies to get to the target goal of 120 that was well-tolerated by individuals, again, across a spectrum of ages and degrees of renal dysfunction, kidney dysfunction, suggesting that indeed these regimens can be done in a way that's both safe and effective at reaching targets in a way that saves lives and indeed, again, prevents heart attacks and strokes.


    All right, Dr. Gary Gibbons from the National Institutes of Health, thanks so much for joining us.


    Thank you.

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