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The People’s Pharmacy: Benefits of aggressive blood-pressure treatment affirmed

Doctors have been debating the pros and cons of aggressive blood-pressure treatment for decades. A large new study called SPRINT (Systolic blood PRessure INtervention Trial) will be stopped prematurely. That’s because the initial results were so promising that the investigators thought it would be unethical to delay publicizing the findings.

This federally funded study was designed to answer the question: “Will lower blood pressure reduce the risk of heart and kidney diseases, stroke, or age-related declines in memory and thinking?” The investigators recruited 9,300 American adults over 50 years old and randomly assigned them to one of two targets for systolic blood pressure, which is the first and higher number in a typical blood-pressure reading of, say, 120/80. It measures the pressure on the blood vessels while the heart is contracting to squeeze blood through them.

Half of these people were assigned to get their systolic pressure below 140, while the other half were to get it under 120, long considered a “normal” level for systolic blood pressure. The study was supposed to run through 2017, but it has just been cut short because the results seemed so clear.

For those in the intense blood-pressure control arm, getting systolic blood pressure under 120 reduced cardiovascular complications by one-third and cut their risk of dying during the study by 25 percent.

The results reinforce the aggressive approach to blood-pressure control that many physicians favor. As long as treatment does not produce serious side effects, it now makes sense to aim for 120 or lower. The investigators don’t yet know whether getting blood pressure that low among older people will help or harm mental function.

Before millions of senior citizens are prescribed two, three or more medications to drastically lower their blood pressure, people need to seriously consider the benefits of nondrug approaches. Losing even a little weight, becoming more fit through exercise, learning to reduce stress and eating a diet that features vegetables and fruits all can be helpful. The DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets both have solid scientific data to back up their benefits.

When lifestyle change is not enough, medications can make a difference. But it always is essential to weigh the pros and cons of drugs. One of the most common complaints of older people taking blood-pressure medicines is dizziness. In some cases, this can lead to unsteadiness and falls. A broken hip is a catastrophe that can lead to permanent disability or early death.

We have written about various ways to control hypertension, including many sorts of medications, in our Guide to Blood Pressure Treatment. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. B-67, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

People should get in the habit of measuring their own blood pressure. Even those under 50 can benefit from better blood-pressure control. Getting regular feedback on blood pressure can help provide motivation for meeting exercise and diet goals.

Joe Graedon is a pharmacologist. Teresa Graedon holds a doctorate in medical anthropology and is a nutrition expert. Their syndicated radio show can be heard on public radio. In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of this newspaper or email them via their website: www.PeoplesPharmacy.com