The press with an assist from the American College of Cardiology is trying to drive the American public crazier than it usually is. Here’s a quotation typical of those floating around the media: “Nearly half of Americans have high blood pressure under the new guidelines issued Monday by heart organizations and the medical community. The threshold for high blood pressure has been lowered to 130/80 mmHg from the previous 140/90.”
This supposedly came from the College’s analysis of the Systolic Blood Pressure Intervention Trial – SPRINT. Here is the ACC’s analysis of the SPRINT study. SPRINT examines the effect of systolic blood pressure lowering to <120 mm Hg compared to the usual 140 mm Hg in patients over 50 at high risk for cardiovascular disease. The College’s interpretation of the data is below:
The results of this landmark trial indicate that intensive BP lowering to a target <120 mm Hg is superior to routine management with a target of <140 mm Hg in high-risk nondiabetic patients with hypertension, including in elderly patients. There were also reductions noted in CV and all-cause mortality, accompanied by a reduction in CHF. An intensive strategy also reduced the risk of developing LVH among patients without baseline LVH and resulted in greater LVH regression among those with evidence of baseline LVH. An intensive strategy carried a higher risk of hypotension, syncope, and accelerated reductions in GFR (only in patients without CKD at baseline). This is a landmark trial and is likely to result in a paradigm shift in the management of patients with hypertension. (CV= cardiovascular; CHF=congestive heart failure; LVH=left ventricular hypertrophy; GFR=glomerular filtration rate)
The study demonstrates that nondiabetic patients at high risk for cardiovascular disease over age 50 benefit from vigorous blood pressure lowering. Where is the part that shows that subjects of any age without risk factors for CV disease benefit from vigorous blood pressure lowering? There isn’t any, because such a group was not part of the SPRINT study. It would appear that a group of blood pressure”experts” got together and extrapolated the SPRINT data to the the entire population. There is no scientific foundation for such an extrapolation that I can find. Everyone should stop, take a deep breath, and coolly analyze the data before condemning half the country to a death by a 1,000 cuts.
