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June 25, 2014
Little Benefit in Reducing Systolic Blood Pressure Below 120
Winston-Salem, NC—Is there any limit to how much blood pressure should be reduced to avoid dangerous coronary events? A new study led by Wake Forest Baptist Medical Center researchers suggests the answer is, “Yes.” The study, published recently in JAMA Internal Medicine, found that lowering systolic blood pressure below 120 does not appear to provide additional benefit for patients. “Frequently we treat patients’ blood pressure to the lowest it will go, thinking that is what’s best,” said lead author Carlos J. Rodriguez, MD, associate professor of public health sciences at Wake Forest Baptist. “Our observational study found that treating to low pressures doesn't provide any benefit to patients with regard to reducing risk of dangerous heart events like heart attack, heart failure and stroke. This calls into question the notion that lower is better.” While previous research has linked a progressive increase in heart disease risk with systolic blood pressure (SBP) rising above 115, it was not known whether SBP falling below 120 in patients with hypertension lowered the risk of heart failure, stroke and heart attack, according to background in the study. For the current study, researchers reviewed records of 4,480 participants from the Atherosclerosis Risk in Communities Study who had been followed for 21 years to determine incidence of heart failure, ischemic stroke, heart attack or death related to coronary artery disease. Measurements of SBP were taken at baseline and at 3-year intervals during the study, with SBP categorized as elevated (140 or greater), standard (120 -139), or low (less than 120). In their review, study authors determined that, among participants with high blood pressure, once SBP falls below 140, lowering it below 120 did not further reduce the risk of cardiovascular events. “After a median follow-up of 21.8 years, a total of 1,622 CV events had occurred. Participants with elevated SBP developed incident CV events at a significantly higher rate than those in the low BP group. However, there was no difference in incident CV event-free survival among those in the standard vs. low SBP group. Further adjustment for BP medication use or diastolic BP did not significantly affect the results,” according to the results. “Our study found that the optimal blood pressure range for people with hypertension is120-139, which significantly reduces the risk of stroke, heart attack or heart failure,” Rodriguez added. “These findings suggest that you don't need to go lower than that to have the benefits.” He noted that a large clinical trial under way, the systolic blood pressure intervention trial (SPRINT), would either confirm or refute the findings.
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