“The New Show Down” 

As you know, we believe all women should “Know Your Numbers” and if you have downloaded our handout you know that "normal" blood pressure has a top number (systolic) less than 120 and bottom number (diastolic) less than 80. An elevated systolic pressure (top number), will increase the cardiovascular risk. 

120/80 

So what is the new show down? It is the debate about the “ideal numbers” for non-diabetic adults 50 years and older WITH high blood pressure (BP) and at risk of cardiovascular disease. 

In patients who have a diagnosis of hypertension (high blood pressure) and are on treatment, the question has been, “Should we lower blood pressure to “normal” levels of less than 120/80 or is 140/ enough?” 

There was actually no clear evidence from any of the large studies to answer that question, until the Systolic Blood Pressure Intervention “SPRINT” Trial. This study evaluated the benefits of maintaining the systolic blood pressure, the top number, at 120 mmHg or less versus the established clinical guidelines recommendation of systolic blood pressure of less than 140 mmHg.

About the Study 

The SPRINT Trial enrolled 9,361 non-diabetic adults (excluding diabetics) over the age of 50 with high blood pressure. The study included a diverse population, men and women, racial/ethnic minorities, elderly patients (>75 y/o), patients with history of cardiovascular disease or chronic kidney disease. 

The investigators divided the study participants in two groups, the standard group received blood pressure medications to achieve a systolic BP less than 140 mmHg and the intensive treatment group received medications to get their systolic blood pressure back to normal -- anything under 120 mmHg. 

Everyone followed a low-sodium diet and exercised, and doctors were free to use any combination of medications needed to meet these targets. On average, the participants needed three different medications to get to a goal of 120 mmHg vs only two to get to just 140 mmHg.

What happened in the lower (<120 mmHg) target group? 

Those who achieved 120 mmHg or below had roughly 1/3 fewer heart attacks, strokes, and less heart failure compared to patients who had the slightly higher blood pressure target goal. This meant decreasing death by almost 25%. This is big!!! 

What do I think? Non-diabetic patients with high blood pressure should keep the systolic BP close to 120 mmHg. 

If you have high blood pressure and you are taking medicine: 

• Continue taking your current blood pressure medications.
  
  
• Monitor the BP at home and keep a diary. You are not in any immediate danger unless you try to make changes on your own without talking to your doctor.
  
  
• Systolic blood pressure goal is 120 mmHg. If you want to modify your treatment ask your doctor for feedback and guidance.
   
• Keep in mind under-treatment or non-treatment is the most common cause of preventable death in the world, with an estimated 9 million deaths. This now out ranks tobacco use with 6 million deaths annually. (Frieden T. The Future of Public Health, N Engl J Med 2015; 373:1748-54.) 

Until next time! 

Stephanie Coulter, MD 

Special thanks to Dr. Karla Campos for her assistance in writing Straight Talk.

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