Chris Perzanowski, MD, FACC, FHRS
Hypertension is known to be an important risk factor for cardiac events and stroke. Identification of the ideal target has fluctuated over the years. Overzealous control of blood pressure may itself lead itself to stroke and syncope (fainting) presumably due to hypoperfusion. The SPRINT trial was a large (9300 patients) multicenter trial which randomized patients over the age of 50 to intensive blood pressure control (120 mmHg systolic) vs conventional (140mmHg) control.1
Although the absolute risk reduction was narrow, the large number of subjects allowed for favorable determination for the strict blood pressure control arm. The results showed a risk reduction of developing a composite endpoint of myocardial infarction, heart failure or stroke by nearly a third. More intensive control appeared to confer a mortality benefit as well.
However, cardiologists have a distinct concern that 120 mmHg is too low for older patients. Fainting and adverse effects secondary to medications are common problems in seniors, and antihypertensive drugs are often responsible. Hence, a fifty year old is widely considered to be a young patient, while eighty is categorically elderly.2 Whether, the SPRINT conclusions can be applicable to all patients above the age of 50 remains to be seen. Ultimately, medical judgement with regard to the individual patient is needed.3
- Landmark NIH study shows intensive blood pressure management may save lives
- Do published SPRINT study results live up to premature NIH news release hype?
- Bove AE. Four days in Orlando. Cardiosource World News. Dec 2015:13