Intensive Blood Pressure Control May Extend Life in Adults with Hypertension

A 50-year old patient with high blood pressure could expect to live almost 3 years longer with more intensive blood pressure control that is focused on a target systolic blood pressure of less than 120 mm Hg, according to a study presented at the American Heart Association’s Scientific Sessions 2019 in Philadelphia, PA.¹

Globally, an estimated 1.13 billion individuals have hypertension, which causes about 13% of all deaths, according to the World Health Organization. Almost 1000 individuals in the United States die each day with high blood pressure as a primary or contributing cause, according to data from the CDC. Most of the time there are no obvious symptoms, but certain physical traits and lifestyle choices can put patients at a greater risk.²

Lead study author Muthiah Vaduganathan, MD, MPH, an instructor of medicine at Harvard Medical School and associate physician at Brigham and Women’s Hospital in Boston, said that preventative techniques such as blood pressure control are important steps to prolong a patient’s life free from disease or disability.²

“High blood pressure has been implicated as one of the reasons for stalled progress in reducing heart disease-related deaths in the United States. These data reinforce that tighter blood pressure control, especially when started earlier in life, may meaningfully prolong life span,” Dr Vaduganathan said in a press release.²

A patient at age 65 with high blood pressure could extend their life by more than a year with intensive treatment, the research estimated. A patient at 80-years old would be expected to add almost 10 months to their life span.¹

The study builds on the 2015 findings of the landmark Systolic Blood Pressure Intervention Trial (SPRINT) which tested the value of treating blood pressure intensively to reduce systolic readings to a lower target of below 120 mm Hg, instead of the routinely used target of below 140 mm Hg.¹

SPRINT enrolled 9361 middle-aged and older adults with systolic readings of 130 to 180 mm Hg, who were at risk of heart disease but did not have diabetes. Patients were at high risk of heart disease if they had at least 1 of the following: evidence of cardiovascular disease other than stroke, a high 10-year cardiovascular risk score, chronic kidney disease, or if they were age 75 years or older.¹

At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2. mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significant lower rate of myocardial infarction in the intensive-treatment group.¹

Targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. The intensive approach reduced patients’ risk of cardiovascular events, such as included heart attack, stroke, heart failure, and cardiovascular-related death, by 25%.¹

Additionally, intensive treatment for high blood pressure lengthened patients’ remaining life span by 4% to 9%, compared with standard care across age groups, the study found. “In contrast with the oldest patients, middle-aged patients had the greater absolute benefit because they start with a longer expected life span and can receive the intensive treatment over a longer period of time,” Dr Vaduganathan said.²

The analysis of the SPRINT trial suggests that there’s additional years of life that can be added by more aggressive control of blood pressure, Mitchell S.V. Elkind, MD, president-elect at American Heart Association, Chair of the Advisory Committee of the American Stroke Association, and professor of neurology and epidemiology at Columbia University in New York, said in the press release.² “When you tell people that lowering their blood pressure is going to reduce their chance of having a stroke or a heart attack, by 25%, which is what [SPRINT] showed, but what does that number mean, in real terms? This analysis suggests that for a man who is 50 years old, that lowering blood pressure to [the lower blood pressure] targets, could extend your lifespan by 3 years, on average,” Dr Elkind concluded.

Reference

• A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015; 373:2103-2116. DOI: 10.1056/NEJMoa1511939. Published November 26, 2015. https://www.nejm.org/doi/full/10.1056/NEJMoa1511939. Accessed November 13, 2019.
• Studies explore potential benefits and costs of increased treatment to achieve lower blood pressure targets [press release]. American Heart Association Scientific Sessions. Published November 11, 2019. https://newsroom.heart.org/news/studies-explore-potential-benefits-and-costs-of-increased-treatment-to-achieve-lower-blood-pressure-targets. Accessed November 13, 2019.