Treatment Goals for Hypertension
The ideal blood pressure has eluded medical experts for decades. For the longest time, a blood pressure of 140/90 or less was thought to be the goal when titrating medications for treatment of hypertension. Then, in recent years, more aggressive treatment of mild hypertension was advocated, despite the potential risks, including fatigue and muscle weakness and increased risk of serious falls. Recognizing this, the pendulum swung back again to a less aggressive approach.
This may change once again as a result of the Systolic Blood Pressure Intervention Trial (SPRINT) sponsored by the National Institutes of Health (NIH) which reported its findings late last year. In this study, 9,361 adults age 50 and older with systolic blood pressure 130 or higher and cardiovascular risk factors (but not diabetes) were randomly assigned to one of two groups. One group had a systolic blood pressure target of less than 140 and the other had a systolic blood pressure target of less than 120. The aggressively treated group faired significantly better.
As reported in the New England Journal of Medicine, the study was stopped after three years when it became clear that those treated more aggressively had ‘lower rates of fatal and nonfatal major cardiovascular events and death from any cause’ than those treated less aggressively. So will the pendulum swing back once again to a more aggressive treatment approach for patients with hypertension? We shall see.