CIO #120
SPRINT blood pressure trial, Sauna and sperm, Longevity science, and More
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“A Randomized Trial of Intensive versus Standard Blood-Pressure Control”
I think it’s commonly known that elevated blood pressure increases one’s risk of cardiovascular disease (CVD); however, in recent years, researchers and medical professionals have debated exactly where we should draw the line for a target blood pressure. (I)
In their study linked above, authors from the SPRINT Research Group explored this question by placing non-diabetic individuals with elevated blood pressure and at higher risk of CVD on treatment plans targeted at achieving blood pressures either less than 120 mm Hg or less than 140 mm Hg. (I)
“We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes.” (I)
Interestingly, though the study was planned to cover, “a maximum follow-up of 6 years,” the researchers stopped it short at ~3 years of follow-up because the subjects in the less than 120 mm Hg group were significantly outperforming subjects in the less than 140 mm Hg group in terms of total cardiovascular events–specifically, “myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or death from cardiovascular causes.” (I)
Amongst other statistically significant differences, the lower blood pressure target group showed 25%, 43%, and 27% lower risks of total cardiovascular events, death from cardiovascular causes, and death from any cause. (I)
Notably, the subjects in the lower blood pressure target group averaged 2.8 blood pressure lowering medications throughout the study, as compared to the higher blood pressure target group’s average of 1.8 medications.(I)
Also, subjects in the less than 120 mm Hg target group showed statistically significant higher risks of some adverse events–like 67% and 33% increased risks of hypotension (i.e. low blood pressure) and syncope (i.e. passing out), respectively–as well as higher risks of acute kidney injury or renal failure (statistically significant 66% greater risk). (I)
The authors generally attributed the increased risk of adverse outcomes and kidney issues to the intensive medication plan required to achieve the target blood pressure in the less than 120 mm Hg target group:
“The differences in adverse renal outcomes may be related to a reversible intrarenal hemodynamic effect of the greater reduction in blood pressure and greater use of diuretics, angiotensin-converting–enzyme inhibitors, and angiotensin-receptor blockers in the intensive-treatment group. With the currently available data, there is no evidence of substantial permanent kidney injury associated with the lower systolic blood-pressure goal; however, the possibility of a long-term adverse renal outcome cannot be excluded. These observations and hypotheses need to be explored further in analyses that incorporate more clinical outcomes and longer follow-up.” (I)
However, in my opinion, the authors still seemed quite bullish on the idea of further decreases in blood pressure–specifically, targeting blood pressures of less than 120 mm Hg–being beneficial for CVD risk, at least in this at-risk population. (I)
“In conclusion, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, in patients at high risk for cardiovascular events but without diabetes resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause. However, some adverse events occurred significantly more frequently with the lower target.” (I)
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