New Lower Blood Pressure Goals Could Be on the Horizon

Last week, the NIH announced it had halted a large study looking at blood pressure control in middle aged and older adults 18 months earlier than planned. The study was halted, the NIH said, not because individuals were in danger, rather because the results were so exceptional they wanted to immediately release the information that aggressive treatments that lowered blood pressure more were beneficial in reducing the rates of death and stroke. 

Turns out those individuals in the trial who attained systolic (top number) readings under 120 experienced a significantly better outcome than those who did not achieve such low levels. Although the details of the trial have not been published, the reductions in rates of death and stroke in the more aggressively treated group were in the 30% range.

The story got a lot of press coverage even appearing on the front pages of the New York Times and Wall Street Journal. So you might be wondering: What does this all mean? Do I need to go to my doctor and get put on more medications?

The honest answer is that we don’t know what this data means – yet. It does go against many other studies that have shown that more aggressive medication-based regimens to lower blood pressure are not associated with better outcomes. Those studies simply showed higher rates of medication side effects, especially in older individuals. It should be noted that in the NIH trial, individuals who attained systolic readings below 120 required 3 medications, on average, to get there.

We simply need to know more about what sorts of subjects were in the trial, what the rates of side effects were, and what sorts of medication regimens were studied before any specific recommendations can be made to individual patients. Details of the trial are expected to be published before the end of the year.

In the meantime, don’t panic. Blood pressure (BP) is something that exerts its effects over the long haul. So there is no need to rush in to the doctor’s office quite yet. But as we await the final trial data, I would urge you to do what I tell all my patients to do: get more involved in your blood pressure management.

  1. Get your own home BP monitor and record your readings. Checking your BP a couple of times a day is a good idea, especially in the first few days. Don’t worry if you miss a day or if you check more than 2 readings on some days. The important thing about checking your home BP readings is to get an idea of what your BP control is outside of the doctor’s office. Home blood pressure monitors are relatively inexpensive, available without a prescription at most pharmacies/pharmacy departments, and are generally very accurate.
  1. At your next doctor’s visit, share your BP readings and also bring your monitor in to be checked for accuracy against office readings. Your home BP numbers are generally more useful for treatment adjustment. After all, you live at home, not in the doctor’s office. But they’re only useful if they’re accurate. 
  1. If you’re seeing top number readings consistently over 150 and especially over 160 on your home monitor, arrange for an earlier appointment. Study or no study, you may require adjustment of your medication regimen.

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