Study: Intensive Systolic Blood Pressure Lowering Could Prevent 100,000 Deaths Annually
Intensive systolic blood pressure (SBP) lowering could prevent over 100,000 deaths per year, according to a new study.
The Systolic Blood Pressure Intervention Trial (SPRINT) randomly assigned 9361 adults aged 50 years or older at high cardiovascular disease (CVD) risk without diabetes or stroke to intensive SBP lowering (≤120 mm Hg) or standard SBP lowering (≤140 mm Hg). After a median follow-up of 3.26 years, all-cause mortality dropped 27% with intensive SBP lowering. The researchers estimated the potential number of prevented deaths with intensive SBP lowering in the US population meeting SPRINT criteria.
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The investigators applied SPRINT eligibility criteria to the National Health and Nutrition Examination Survey 1999-2006, a representative survey of the US population, linked with the mortality data through December 2011. Eligibility included age 50 years or older, with SBP 130-180 mm Hg depending on number of antihypertensive classes being taken, and the presence of 1 or more CVD risk conditions (history of coronary heart disease, estimated glomerular filtration rate [eGFR] 20-59 mL/min/1.73 m2, 10-year Framingham risk score ≥15%, or age ≥75 years). They excluded adults with diabetes, stroke history, greater than 1 g/d proteinuria, heart failure, on dialysis, or eGFR less than 20 mL/min/1.73m2. The researchers calculated annual mortality rates for adults meeting SPRINT criteria using Kaplan-Meier methods and used the expected reduction in mortality rates with intensive SBP lowering in SPRINT to determine the number of potential deaths prevented.
They found an estimated 18.1 million US adults met SPRINT criteria, with 7.4 million taking blood pressure-lowering medications (mean age, 68.6 years; 83.2% non-Hispanic white and 7.4% non-Hispanic black). The annual mortality rate was 2.2%, and the researchers projected intensive SBP lowering to prevent 107,453 deaths per year. Among adults with SBP of 145 mm Hg or higher, the annual mortality rate was 2.5%, and they projected intensive SBP lowering to prevent 60,908 deaths per year.
“Intensive systolic blood pressure lowering in older adults without diabetes and stroke saves lives,” said lead study author Holly Kramer, MD, MPH, associate professor of public health sciences and medicine at Loyola University Medical Center, Maywood, Illinois. “But intensive systolic blood pressure lowering also means additional adverse events like hypotension, electrolytes disorders, and kidney injury, so physicians will need to be vigilant in monitoring patient safety.”
She is working on an implementation study to see how intensive SBP lowering could be potentially implemented in a clinical setting. “What resources does it take? How do physicians feel about systolic blood pressure lowering? Those are the questions we are currently asking,” Dr Kramer said.
—Mike Bederka
Reference:
Kramer H, Bress A, Beddhu S, Muntner P, Cooper RS. Intensive systolic blood pressure lowering will prevent over 100,000 deaths annually. Presented at: Council on Hypertension 2016 Scientific Sessions; September 15, 2016; Orlando, FL. https://professional.heart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_488108.pdf. Accessed September 15, 2016.