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More Evidence of Better Outcomes With 120 mm Hg BP Target
Intensive lowering of blood pressure to a systolic target < 120 mm Hg reduced cardiovascular events among individuals at high-risk for cardiovascular disease compared with standard treatment using a target < 140 mm Hg in the ESPRIT trial.
“Intensive blood pressure lowering treatment targeting a systolic pressure below 120 mm Hg for 3 years resulted in a 12% lower incidence of major vascular events, a 39% lower cardiovascular mortality, and 21% lower all-cause mortality than the standard treatment targeting a systolic pressure below 140 mm Hg,” reported lead investigator, Jing Li, MD, director of the department of preventive medicine at the National Center for Cardiovascular Diseases in Beijing, China.
The trial included patients with diabetes and those with a history of stroke, two important groups that were excluded in the previous SPRINT trial of intensive blood pressure lowering. Results suggested that the benefit of intensive blood pressure lowering extends to these groups.
The results translate into the prevention of 14 major vascular events and eight deaths for every 1000 individuals are treated for 3 years to a target systolic pressure < 120 mm Hg rather than < 140 mm Hg, at the cost of an additional three patients experiencing the serious adverse event of syncope, Li said.
The top killers of Americans remain coronary artery heart disease (26%), cancer (22%), and stroke (6%). The precursors and attributable risk factors for coronary artery heart disease include hypertension (40%), obesity (20 %), diabetes (15%), and combustible tobacco use (15%). The key precursors and attributable risk factors for stroke are hypertension (53 %), obesity (37%), diabetes (9%), and combustible tobacco use (11%). Obviously, these are estimates, with substantial overlap.
Should 120 mm Hg Be New Target?
Commenting on the study for theheart.org | Medscape Cardiology, Paul Whelton, MD, chair in Global Public Health at Tulane University School of Medicine, New Orleans, said that the results were consistent with several other trials.
“When we look at meta-analysis of trials of different levels of blood pressure reduction, all the studies show the same thing – the lower the blood pressure, the better the outcome, with those starting at higher levels gaining the greatest the benefit of blood pressure reductions,” he noted.
He said that guidelines committees will have to consider a lower systolic blood pressure of 120 mm Hg as the optimal treatment target. In the United States, at present, the target is 130 mm Hg.
But he stressed that although there is now good evidence in favor of lower blood pressure targets, these findings were not being implemented in clinical practice.
“We are doing very badly in terms of implementation. There is a big gap between science and what’s happening in the real world.”
Whelton pointed out that only 30% of patients in high-income countries are controlled to the 140/90 target and that in low- and middle-income countries, only 8.8% get to that level, never mind lower targets. “The next job is to work on implementing these findings,” he said.
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