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How Low is Too Low in Blood Pressure Control?

Written by Bryan Heart cardiologist John Steuter, MD

The blood pressure goal when treating hypertension has been a point of varying opinions for quite some time. A recent trial was completed that had a lower systolic blood pressure (SBP) goal of 120mmHg, instead of the current goal of 140mmHg.

This trial has proposed differing recommendations for the most appropriate target for systolic blood pressure (SBP) to reduce the risk of cardiovascular nonfatal and fatal events for a person without diabetes.

This leads us to the questions of, what is the optimal blood pressure goal and how low is too low?

Two Different Studies, Two Differing Recommendations: SPRINT vs ACCORD

SPRINT

This year when the Systolic Blood Pressure Intervention Trial (SPRINT) results were released they showed clinical research based benefits to aiming below the standard target systolic blood pressure (SBP) of 120mmHg. The study showed a 25% relative reduction in the following events for people without diabetes:

  • Myocardial infarction (MI), otherwise known as heart attack
  • Acute coronary syndromes, which are any condition brought on by a sudden reduction or blockage of blood flow to the heart
  • Stroke
  • Heart failure
  • Death from cardiovascular causes in a population excluding diabetes, prior stroke and polycystic kidney disease

ACCORD

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) was released in 2010 and demonstrated a non-significant relative reduction in its primary endpoint of nonfatal MI, nonfatal stroke and death from any cardiovascular causes in patients treated to a goal systolic blood pressure (SBP) or 120mmHg versus 140mmHg.

Outside Opinions on SPRINT v. ACCORD

Many question the difference in the ACCORD trial and how it included patients with diabetes while SPRINT did not. While most experts admit it is possible that inherent differences exist in the benefit of intensive systolic blood pressure (SBP) lowering between diabetic adults and non-diabetic adults, they believe this is unlikely.

Both sides of the argument agree that a third trial that is appropriately powered would be beneficial. In the meantime, guidelines and practitioners will have to decide whether the SPRINT results should be generalized to patients with diabetes and what target blood pressure to aim for.

Where Do We Go From Here?

If practitioners aim to achieve the lower target systolic blood pressure (SBP) this will require them to have a more thorough discussion with their patients about the risk/benefit of adding more medications.


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About John Steuter, MD

John Steuter, MD, is a cardiologist at Bryan Heart. Steuter is a graduate of The University of Nebraska Medical Center College of Medicine and joined Bryan Heart in 2015 after completing his residency and fellowship at The University of Nebraska Medical Center. He is certified with the American Board of Internal Medicine.

View Dr. Steuter’s physician profile.

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