Treating high blood pressure is a marathon, not a SPRINT

by David Becker, M.D.

Published Nov. 10, 2015, 10:55 a.m. ET

This week, the phones will be ringing off their hooks in my office from anxious patients concerned about the results of the SPRINT trial. Along with results of a second trial published last week in the British journal Lancet, new information suggests that many people with high blood pressure may need more medication. Ouch!

Optimal blood pressure (BP) numbers – less than 120/80 — has never been questioned. Yet, just last year, physicians were telling patients that they can relax a bit about their blood pressure, as long as it is less than 140/90 (and maybe even 150/90 if they are older). Now, based on results from the SPRINT trial, it looks like more medication to further lower blood pressure may be better. But, no one wants to be on another pill!

Losing weight, watching salt intake, deep breathing techniques, and exercising can make a huge difference in the treatment of high blood pressure, but the sad fact is that many of us need medications for hypertension, even if we do everything right. However, medications can cause side effects, and other studies have suggested that treating BP too aggressively with medications can lead to falls, lightheadedness, and sometimes do more harm than good.

Here is what you need to know about the SPRINT trial:

If you have high blood pressure and other risk factors for heart disease, than a BP target with the top number (systolic) under 120mmHg was associated with a 27 percent decreased risk of dying, when compared to a systolic BP of 140 mmHg.
Older adults with high BP who have had a heart problem, lots of cardiac risks, or have chronic kidney disease may especially benefit from more aggressive BP control.
There were increased side effects seen in the group that took more medication to lower their BP, but the study concluded that these side effects were mild when compared to the positive results.

Based on this new information, combined with some common sense, here is what I suggest:

Do not panic if your BP is higher than 120/80. A few elevated BP readings will not increase your risk in the short term. The decision to be on more medication should be made carefully, and after much discussion with your doctor.
Losing weight, exercising, watching salt, and dietary changes such as eating foods rich in potassium remain very important, especially if your BP is borderline, and may still help you avoid being on medication.
"White coat hypertension" is a major problem. Getting your pressure checked in the doctor's office can be scary for some so I advise getting readings in a less threatening environment. Begin a log, with pressures taken either at home, a local pharmacy or supermarket, and bring them with you when you see your doctor. Make sure you use a BP device that is automatic and works on your upper arm, as wrist cuffs are notoriously inaccurate. If you know a friend who is a doctor, nurse, or EMT, and they have their own device ask them to take your BP once or twice per week.
Take your BP at different times of the day, with up to three readings in a row that you can average. If elevated in the morning or night, your medications may need to be taken at a different time of the day. Try not take your BP multiple times throughout a single day as the anxiety this will cause may be worse than an elevated reading
If your BP is up, and you have multiple risk factors for heart disease, then two or three medications may be needed to lower your BP. There are lots of choices of generic (inexpensive) medications available for BP treatment, and it may take a while to find the right combination with minimal side effects.
If you are on a diuretic (water pill), the new study suggests that changing to another one called chlorthalidone may be especially effective, often when combined with other classes of medications called ACE/ARB's or calcium channel blockers.

The most important advice is to remember that it if treating high BP is akin to a race, it is more of a marathon than a SPRINT. Hopefully, the results of this study will help open up dialogue between doctors and patients about how to best treat high BP, with discussions about the benefits of treatment compared to the risks of side effects

Dr. David Becker is a board certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. and has been in practice for 25 years. In 1993, after extensive research, Dr. Becker launched Healthy Change of Heart, an innovative 10-week program designed to reverse heart disease and improve quality of life through diet, exercise, and stress management. Since then, thousands of patients have participated in the program, achieving significant results in improving cardiac wellness.