Study: Aggressive blood pressure management may save lives

A new study finds that more aggressive treatment of high blood pressure in certain high-risk patients may extend their lives, the National Institutes of Health said Friday.

Over a period of three years on average, patients were nearly 25 percent less likely to die if they took enough medicine to reduce their systolic blood pressure - the higher of those two numbers you hear at the doctor's office - to 120. Those patients were compared with a second group whose target systolic pressure was 140.

Patients who got the more aggressive treatment also were 30 percent less likely to suffer a cardiovascular event such as a heart attack or stroke during the study period, the NIH said.

"This study shows that intensive blood-pressure management can prevent the cardiovascular complications of hypertension and save lives," said Jackson T. Wright Jr. of Case Western Reserve University, a study author.

But what the study means for patients struggling with blood pressure is not yet clear.

Wright and fellow authors did not reveal the actual numbers of deaths and other adverse events in the 9,300 patients, several dozen of whom came from Temple University Hospital and the Hospital of the University of Pennsylvania. Nor did they break down the results by categories, such as those with kidney disease, leading some physicians to label the fanfare as early.

"It's a little premature to get too excited about the finding without being able to study the results," said Harlan Krumholz, a prominent Yale University cardiologist. "All we got is a news release."

In a media teleconference Friday, authors said the results were so compelling that they decided to stop the trial a year early. But they acknowledged that the findings were not yet peer-reviewed, and said a full study would be published by the end of the year.

So in the meantime, does a 25 percent reduction in death mean that three people died in the group that got extra medicine, vs. four deaths in the other group? Or does it mean 30 deaths vs. 40? No way to tell, said Jeremy Faust, an emergency physician at Mount Sinai Hospital in New York, who was among those on Twitter registering reservations about the study.

"Without the data, we literally don't know whether this is huge news or meaningless PR," Faust said.

Still, area cardiologists said that the preliminary findings seem promising, especially with the backing of the NIH.

Currently, people with high blood pressure and other cardiovascular risk factors, such as diabetes or kidney disease, are typically urged to shoot for a systolic blood pressure of 130. Otherwise-healthy adults are urged to stay below 140.

The guideline for seniors is a bit looser, at 150, because physicians do not want to run the risk that their patients lower their blood pressure too much and faint as a result.

But if the results of the new study hold true, physicians should be treating the condition more aggressively, said Veronica Covalesky, a cardiologist with Cardiology Consultants of Philadelphia. That is especially true because most drugs in question are available as low-cost generics, she said.

"We have a large armamentarium of available, effective blood-pressure medications" that are generic, Covalesky said.

The Centers for Disease Control and Prevention estimates that one in three adults has high blood pressure, a condition that increases the risk of heart disease and stroke, two of the leading causes of death for Americans.

In the study, the patients aiming for a pressure of 140 were given two medicines on average - typically a diuretic, along with another pressure-lowering drug from one of several classes, including ACE inhibitors and calcium-channel blockers.

Patients in the more aggressive treatment group were given three medicines on average.

Crystal Gadegbeku, who oversaw the portion of the trial at Temple, said she was surprised to learn that the extra medication made such a difference, at least on a percentage basis.

"This answers a major question about how to manage one of the most common diseases that we treat," said Gadegbeku, Temple's chief of nephrology, hypertension, and kidney transplantation.

Still, it makes sense to wait for the full study before changing anyone's treatment, said Phillip Koren, medical director of the Cooper Heart Institute in Camden, who was not involved with the research.

"I think it merits further investigation and analysis," Koren said. "I would say, wait and see."