May 8, 2021

GOOD NEWS FOR DRUG COMPANIES: One in 5 people in U.S. uses blood pressure-raising medications. “‘We’re not telling patients they can’t take these medications,’ Yang stressed. Instead, he said, ‘we treat the high blood pressure.'”

Of course, it’s partly a matter of definitions: “In 2017, the ACC and American Heart Association changed their definition of high blood pressure, lowering it from the old threshold of 140/90 mm Hg.”

Related: With Blood Pressure, Lower Is Not Always Better.

The observational study, published online in JAMA Internal Medicine, involved 4,480 people. In the 22 years covered by the study, there were 1,622 heart attacks and other serious cardiac problems. Cardiac events were more common in people whose blood pressure exceeded 140, and particularly among those with readings over 160.

But there was no difference in the risk for heart failure, stroke or heart attack between those in the normal range (120 to 140) and those with a level below 120. Researchers controlled for smoking, use of blood pressure drugs, and other variables.

Related: Why the New Blood Pressure Guidelines Could Lead to Harm.

The problem was not the guideline itself but some of the news coverage it prompted, with pronouncements that millions more Americans would need to lower blood pressure or that nearly half of Americans now had high blood pressure. A lot of the coverage made it sound as if something drastic had happened overnight.

Nothing had. We just changed the definition of hypertension. . . .

The results were significant, with fewer patients in the intensive therapy group having an acute cardiovascular event or death. The evidence was so compelling that the trial was stopped early, so the results could be announced sooner rather than later. This decision itself brought a fair amount of media attention to its findings. The fact that those in the intensive therapy group also had more adverse events, like hypotension, syncope and acute kidney injury, got less attention.


The Sprint study essentially showed that people truly at high risk should have their blood pressure managed more aggressively than we thought. But that has not been the message of news on the new guidelines. That has focused far more often on the many newly reclassified people with mild blood pressure, who were not the focus of the Sprint intervention.

In fact, almost none of the newly labeled hypertensive people (those with systolic blood pressure between 130 and 140) should be placed on medications. These people should be advised to eat right, exercise, drink responsibly, and not smoke.

That’s exactly what physicians would have been advising people before these changes.

More at the link.

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