Time to Reassess Blood Pressure Goals
BU President Emeritus Aram Chobanian comments in NEJM Perspective article
High blood pressure, or hypertension, is a major health problem that affects more than 70 million people in the US and over one billion people worldwide. Despite being a critically important risk factor for heart and kidney disease, defining the “optimal” blood pressure has been a challenge.
In a Perspective article in the November 9, 2015, issue of the New England Journal of Medicine, Aram Chobanian, Boston University President Emeritus, writes that recent findings from the National Institutes of Health’s SPRINT (Systolic Blood Pressure Intervention Trial) suggest that lowering systolic blood pressure to less than 120, compared to a target of 140, was associated with a much lower incidence of cardiovascular disease as well as a reduction in overall mortality by 25 percent. While the results are not applicable to every patient, Chobanian, who is a professor of medicine at the Boston University School of Medicine and an expert on hypertension, states that the results suggest that the target blood pressure in treating hypertension should be lower than is currently recommended. Based on the evidence, he would now advocate a target level of 130 for most non-diabetic individuals above age 50 who have hypertension.
Chobanian acknowledges that there were complications to aggressive blood pressure control as described in the study, such as fainting, abnormal blood levels of electrolytes, and acute kidney injury. He is also cognizant of the fact that for many patients, especially those on multiple medications, a target of 120 or 130 may be difficult to achieve, and will “probably require more careful titration of medications, greater use of combination drug preparations, more monitoring for adverse effects, and more frequent patient visits than currently occur.”
Despite the incredible breakthroughs in the medical therapy for hypertension, Chobanian remains concerned by the “continued increase in prevalence of hypertension in the United States and worldwide during this period and disappointed by weak national efforts to prevent hypertension.” He partly attributes this to the difficulty in modifying human behavior, especially concerning good diet and exercise, and thus “will require a broad-based national effort with strong political support.”
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