The American Heart Association and American College of Cardiology lowered the bar for hypertension last November, updating clinical guidelines to include all individuals with a systolic blood pressure (SBP) above 130 mm Hg as hypertensive. But a new study published in the American Journal of Preventive Medicine suggests treating patients too aggressively for their blood pressure exposes them to higher risks of fainting and experiencing dangerous falls.
Among 477,516 people in the Kaiser Permanente Southern California health system who were treated for high blood pressure, those who reached SBPs below 110 mm Hg at any point during a one-year period were twice as likely to faint or fall as patients who remained above that threshold.
“Efforts to reduce blood pressures for patients with hypertension are an important factor in reducing the risk of heart attack and stroke,” lead author John J. Sim, MD, a nephrologist at Kaiser Permanente Los Angeles Medical Center, said in a press release. “But our study shows that attaining a lower blood pressure could create to a subpopulation of patients whose blood pressures may go too low, which can pose risk for serious falls and fainting.”
The study population was 65 years old on average and possessed a mean SBP of 129 mm Hg. Twenty-seven percent of patients experienced a minimum SBP below 110 mm Hg during one year of follow-up, while 3 percent had a mean SBP below that cutoff.
Compared to patients with SBP above 110, those with a mean SBP below 110 were at a 54 percent increased risk of a serious fall or syncope. People with the minimum reading below that threshold showed 2.18-fold times the risk of a fall or syncope.
“Physicians considering lower blood pressure targets for their patients should weigh the risks and benefits of aggressive blood pressure lowering on an individual basis, especially in older patients,” Sim said.
Serious falls cause significant morbidity and mortality among elderly patients and have been identified as a major public health concern, the authors noted. Older patients are more prone to acute reductions in blood pressure such as orthostatic hypotension and have slower reflexes to normalize their blood pressure.
Those characteristics may explain why people with only a minimum SBP below 110 mm Hg were more likely to have serious fainting or falling episodes compared with those who maintained very low blood pressure throughout the study period.
“These findings from a routine clinical environment with successful (hypertension) control rates suggest that frequent BP monitoring and low BP thresholds for medication modification should be considered,” the researchers wrote.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.