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Hypertension ... The Silent Killer

Posted by David Zuehlke, MD, Freeman Heart & Vascular Institute, on January 20, 2016

High blood pressure, also called hypertension, affects about 80 million Americans. Known as the silent killer, hypertension wreaks havoc on hearts, kidneys and extremities for many years before symptoms suggest its presence. For this reason, physicians have been aggressive in attempts to get their patients’ blood pressure to safe levels. The problem is in defining blood pressure safe levels.

Two years ago, the American College of Cardiology issued guidelines that greatly relaxed the targets for blood pressure control. These new guidelines, citing targets of systolic pressure of 140 in most adults and 150 in the older population, were met with some skepticism in the medical community. Most physicians felt lower targets were more appropriate.

The Systolic Blood Pressure Intervention Trial (SPRINT), funded by the National Institutes of Health, recently formed to study whether lower blood pressure reduces the risk of heart and kidney diseases, stroke or age-related declines in memory and thinking. Approximately 10,000 patients ages 50 and over who were at high risk of heart disease or had kidney disease participated in the study. The study was expected to conclude in 2017, but it was halted early because a significant advantage was demonstrated in the group whose blood pressure targets were lower. Keeping blood pressure at or below 120 led to a statistically important decrease in heart attack and stroke, with an acceptable risk of side effects. Not surprisingly, the downside includes a larger number of medications necessary to reach lower target levels. The increased cost of additional prescriptions and side effects of each prescribed medication were offset by the gains in reduced heart attack and stroke.

Although adoption of the newly recommended blood pressure targets has not yet urged a reissuance of new guidelines, the trend will certainly be toward tighter pressure control for all patients. This will especially be viable for patients with known heart, brain or vascular disease. Cardiovascular disease is still the leading cause of death in the United States and lower blood pressure goals can reduce overall mortality rates.

People with high blood pressure should not panic. High blood pressure takes it toll slowly, and the good news is that there are hundreds of medicines with widely varying mechanisms of action that can be used for control. You and your healthcare provider will likely be able to find a program that can safely and effectively reach your goal.

As we begin a new year, pledge to lose weight, stop smoking, exercise and begin to lead a healthier lifestyle that can help lower your blood pressure.