Aggressively dropping systolic BP
could save 100,000 U.S. lives a year

Researchers in Chicago concluded from a recent analysis of a large multicenter center that intensive treatment to lower systolic blood pressure to below 120 mm Hg would save more than 100,000 U.S. lives a year. Two thirds of those lives would be men and two thirds would be 75 or older, according to Holly Kramer and her colleagues at Loyala University Chicago Stritch School of Medicine. Current guidelines recommend keeping systolic blood pressure below 140 mm Hg. The team applied findings from SPRINT (Systolic Blood Pressure Intervention Trial), which enrolled more than 9,350 adults age 50 or older with high blood pressure and a high risk of cardiovascular disease, to the U.S. adult population. Loyola University Medical Center was among the centers that participated in SPRINT, a study that found there was a 27 percent reduction in mortality from all causes when systolic blood pressure was lowered to below 120 mm Hg, compared to the standard care of lowering blood pressure to below 140 mm Hg. But there is a downside to an intensive blood pressure regimen. The Loyola researchers estimated that applying the regimen to U.S. adults who meet SPRINT criteria – a population of nearly 18.1 million – would also cause about 55,500 more episodes of low blood pressure, 33,000 more episodes of fainting, and 44,400 additional electrolyte disorders each year. Most of these effects are not expected to have lasting consequences, however, and are reversible by lowering blood pressure medications, Kramer said. In the SPRINT study, patients who were treated to achieve a standard target of less than 140 mm Hg received an average of two different blood pressure medications. The group treated to achieve a target of less than 120 mm Hg received an average of three medications. The study excluded certain patients, including diabetics and smokers.

. . . But there's a catch to intense
anti-hypertension therapy

While aggressively lowering systolic blood pressure may save lives, there may be a problem with following a more intense blood pressure lowering regimen. a separate analysis of the SPRINT data found that driving diastolic blood pressure too low is linked to damaged heart tissue. Johns Hopkins Medicine researchers cautioned, however, that they were not able to prove that very low diastolic blood pressure directly cause the heart damage, only that there appears to be a statistically significant increase in heart damage risk among those with the lowest levels of diastolic blood pressure. The take-home message of their study, according to J. William McEvoy, assistant professor of medicine and member of the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins, is that using blood pressure drugs to push patients' systolic blood pressure to 120 mm Hg, the consequences in those starting out with low diastolic blood pressure – below 80 mm Hg, for example – may increase the likelihood that the diastolic number falls so low that it puts the patient at risk of damaged heart tissue. So there should be modification of intensive anti-hypertensive treatment recommendations issued last year as a result of SPRINT, according to McEvoy. "Physicians shouldn't look at driving down the top blood pressure number (the systolic number) in isolation without considering implications of lowering the bottom number," he said. His team's findings were summarized Aug. 30 in the Journal of the American College of Cardiology.

Don't 'disregard' stroke, heart
disease risk in older people

No age group is immune to cardiovascular disease risk factors, and prevention efforts should target all adults – including those over 65 – according to findings published in the Journal of the American Geriatric Society, which are part of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The REGARDS study evaluated stroke incidence in about 30,000 people and is funded by the National Institutes of Health's National Institute of Neurological Disorders and Stroke (NINDS). Claudia Moy, acting director of the Office of Clinical Research at NINDS, said it is important to improve risk factor prevention and management for stroke and heart disease across the lifespan, including older adults, because the life expectancy continues to increase. The REGARDS study included a sample of black and white Americans, with more than half of the participants living in what is known as the Stroke Belt – the Southeastern U.S. – where stroke mortality is higher than in the rest of the country. George Howard, a biostatistics professor at the University of Alabama Birmingham led the current study, which examined people over the course of 10 years to determine how many developed risk factors known to be associated with stroke and heart disease, specifically high blood pressure, diabetes mellitus, high cholesterol, and atrial fibrillation. Smoking is also a risk factor for stroke and heart disease, the authors noted, but most people don't start smoking after the age of 30, so that was not a risk factor they focused on.

WHF armed for AF battle

Cardiovascular orgnaizations all over the world are fighting a common battle – non-valvular atrial fibrillation (AF), which often goes undetected because there are no symptoms. The World Heart Federation (WHF) launched a new roadmap initiative aimed at preventing AF and improving its management worldwide, as the incidence of AF continues to rise. New findings indicate that between 1990 and 2013 the overall number of diagnosed AF cases globally increased from below 7 million to just above 11 million, the WHF noted. The organization said that is likely to underestimate the true scale of AF because so many people do not even know they have the condition. Undetected AF increases the risk and severity of stroke and heart failure and is linked to higher health care costs, the WHF pointed out. The new roadmap was developed to identify areas where improvements can be made that will lead to better management of AF on a global scale, especially in low and middle income countries where research suggests patients tend to be younger and more likely to experience heart failure. This is part of a wider WHF initiative that is aimed at lowering premature death rates from non-communicable diseases, including cardiovascular disease, by 25 percent by 2025.

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