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Would Aggressively Reduction Of Blood Pressure Cut Heart Disease Risk?
 

Number of people living with hypertension (high blood pressure) is expected to reach 1.56 billion worldwide by the year 2025. In the United States alone, about a third of all people over the age of 20 years have hypertension in the year between 2011 and 2012.

While lifestyle factors like physical inactivity, salt-rich diet, alcohol drinking and smoking are usually blamed for causing hypertension, other risk factors like obesity, age, family history of hypertension can also be responsible for putting one at risk of hypertension. What worry health experts is that hypertension can raise one’s risk of getting cardiovascular disease (heart disease and stroke), kidney failure and other health disorders.

Hypertension occurs when one’s blood pressure is higher than 140 over 90 mmHg. This means the systolic reading (the pressure as the heart pumps blood around the body) is over 140 mmHg or the diastolic reading (as the heart relaxes and refills with blood) is over 90 mmHg.

Obviously, people with hypertension should appropriately be treated, either by changing lifestyle or taking anti-hypertensive drugs in order to bring the blood pressure below 140/90 mmHg, the commonly used target. But a large American government-sponsored study showed that lowering blood pressure below 140 mmHg would significantly reduce serious heart problems and cut the risk of death in adults aged 50 and above.

In the study of 9361 persons with a systolic blood pressure of 130 mmHg or higher and an increased cardiovascular risk, but without diabetes, using a combination of medicines to reduce systolic pressure to a target of 120 mmHg would cut the rate of heart attacks, strokes and heart failure by almost a third and the risk of death by nearly a quarter. Their findings were unveiled on November 9, 2015 during the presentation at the American Heart Association’s Scientific Session 2015 and were subsequently published November 26 in the ‘New England Journal of Medicine’.

Patients in the study, which was conducted between 2010 and 2013 and sponsored by the National Heart, Lung, and Blood Institute (NHLBI), had a mean age of 68, with 25 percent over 75, and were considered to be at high risk of heart disease or had kidney disease. It did not include patients who had a prior stroke or those with diabetes.

The patients were divided into 2 groups: one with intensive and the other with standard treatment. The intensive treatment group received an average of 3 blood pressure-reducing medicines and was targeted to lower the systolic blood pressure to below 120 mmHg, and the standard group was taking an average of 2 medicines to bring the blood pressure to below 140 mmHg. The additional medicine added in the intensive group was from a variety of classes available as inexpensive generic drugs. The classes include angiotensin receptor blockers, calcium channel blockers, ACE inhibitors and diuretics.

While adverse side effects in the intensive treatment group were still being analyzed, the study, which was scheduled to last for 5 years, was stopped almost 2 years earlier when the significant benefits of intense treatment became obvious.

Analysis of the study indicated that heart failure, a leading cause of hospitalizations, was reduced by 38 percent, and death from heart-related causes was 43 percent lower among patients in the intensive treatment group. The rate of kidney problems was 4.1 percent in the intensive group compared to 2.5 percent for the standard group.

However, patients in the intensive treatment group had 1 to 2 percent higher rates of adverse side effects, including hypotension, fainting, electrolyte abnormalities and, kidney damage or failure. There were 30 percent of the patients in the study had chronic kidney disease. One thing the researchers found comforting was that patients aged above 75 years did not have additional problems tolerating the intensive treatment.

Researchers are still analyzing the data to see whether more intensive blood pressure lowering affects cognitive decline one way or the other, or has an impact on long-term kidney disease.

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