Caution urged over aggressive hypertension treatment
Friday August 11th, 2017
Aggressively reducing blood pressure in some older people can increase the risk of falls and blackouts, Irish doctors have warned.
The warning has come from medical researchers at Trinity College Dublin, Ireland, after their study findings differed significantly with those from recent research undertaken in the USA.
The Systolic blood Pressure Intervention Trial (SPRINT) trial in the USA showed that lowering systolic blood pressure to levels of 120mmHg or less – compared with 140mmHg or less – in adults over 50 years of age with cardiovascular risk significantly reduced death from all causes and from heart failure and heart attacks.
The US study also said that common side effects of low blood pressure, including falls, injuries, blackouts, and drops in blood pressure after standing, did not increase following the aggressive treatment, even in those over 75 years.
However, researchers from the Irish Longitudinal Study on Ageing (TILDA) at Trinity College Dublin and Beaumont Hospital, Dublin, found very different results in their trials, according to a report published in <i>JAMA Internal Medicine</i>.
The team focused on people in Ireland over 75 years and examined rates of falls, injuries, blackouts and excessive drops in standing blood pressure in those who met the criteria for the treatment proposed in SPRINT. They were also followed up for 3½ years, as SPRINT trial patients were.
The Irish study found that falls and blackouts were up to five times higher than reported in SPRINT, while falls in blood pressure on standing were almost double that reported in the US research.
The TILDA team is now assessing how best to determine which people may benefit from SPRINT, and which people are more at risk from aggressive blood pressure lowering.
First author Dr Donal Sexton, said: "SPRINT was a landmark study of hypertension treatment. While the benefits of lowering blood pressure seen in this study are not in dispute, we are highlighting to physicians that we need to be cognisant of the fact that the trial was not powered for adverse events such as falls causing injury.
“Physicians ought not to expect a similarly low rate of adverse events in clinical practice as was observed in the trial when lowering blood pressure in older people. Overall what we are saying is that the risks and benefits of lowering blood pressure should be individualised for each patient.”
Professor Rose Anne Kenny, founding principal investigator with TILDA and lead author, added: "Our work and that of other groups has shown that low blood pressure and particularly drops in standing blood pressure are linked not only to falls, fractures and fall- and blackout-related injuries, but also to depression and possibly other brain health disorders.
"These outcomes can seriously impact on independence and quality of life and we advise caution in applying the SPRINT recommendations to everyone over 75 years without detailed assessment of an individual's risk versus possible benefit until such a time as we can provide more clarity re treatment."
JAMA Internal Medicine 17 July 17 2017; doi:10.1001/jamainternmed.2017.2924
Tags: Elderly Health | Europe | Heart Health | Pharmaceuticals
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