January 19, 2020

Why you might want more blood pressure medicine

We’ve known for over a generation that using medications to lower high blood pressure can decrease the risk of strokes, heart attacks, and kidney failure. National guidelines have recommended using medications to get the systolic blood pressure (the higher blood pressure number) below 140. So for my whole career a systolic in the 130s would lead to me pat the patient on the back and declare victory, while a systolic in the 140s would lead me to increase a dose of a medication or stress to the patient that she needed to exercise and lose more weight.

I will now have to change that long-standing habit.

A groundbreaking ” target=”_blank”>This video has an excellent summary of the dramatic findings.

The intensive treatment group had significantly fewer strokes, heart attacks, and deaths. That last finding is especially striking because treatments that are proven to actually prolong life are very rare. For every 61 people in the intensive treatment group one stroke or heart attack was prevented. For every 172 people in the intensive treatment group there was one fewer death.

The benefits did not come without side effects. More people in the intensive treatment group had excessively low blood pressure, fainting, and temporary kidney injury. The patients on the intensive group also, on average, required one additional medication compared to the standard treatment group. But the numbers of these additional adverse events were quite modest compared to the large benefits. There were about two adverse events per life saved. That’s not bad.

This study will cause a major shift in how we treat elevated blood pressure. Aiming for a systolic blood pressure goal of 120 will require patients to take more medicines, perhaps suffer more side effects, and attend more doctor visits as their medications are adjusted. But the potential payoffs will be worth it.

So don’t be surprised if I want to increase your blood pressure medication at your next visit. That systolic blood pressure of 134 was terrific a few months ago. But now we know we can do better. And we owe it to you to try.

Learn more:
” target=”_blank”>Data on Benefits of Lower Blood Pressure Brings Clarity for Doctors and Patients (NY Times)
” target=”_blank”>A Randomized Trial of Intensive versus Standard Blood-Pressure Control (NEJM article)
” target=”_blank”>A SPRINT to the Finish (NEJM editorial)

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