Nearly 17 million U.S. adults may benefit from lowering systolic blood pressure goal

A cross-sectional, population-based study found that 16.8 million U.S. adults may benefit from lowering their systolic blood pressure goal to less than 120 mm Hg based on them meeting eligibility criteria for the SPRINT (Systolic Blood Pressure Intervention Trial) study.

Lead researcher Adam P. Bress, PharmD, MS, of the University of Utah, and colleagues published their results online in the Journal of the American College of Cardiology on Feb. 1.

Between 2010 and 2013, the SPRINT trial enrolled 9,361 adults and evaluated if lowering systolic blood pressure to less than 120 mm Hg reduced cardiovascular disease risk compared with a goal of 140 mm Hg. Patients were eligible if they were at least 50 years old, had systolic blood pressure of between 130 to 180 mm Hg and had high cardiovascular disease risk. The researchers defined high cardiovascular disease risk as a history of coronary heart disease, an estimated glomerular filtration rate of 20 to 59 ml/min/1.73 m2, a 10-year cardiovascular disease risk of at least 15 percent and an age of 75 or older.

Patients were excluded if they had diabetes, a history of stroke, heart failure or an estimated glomerular filtration rate of less than 20 ml/min/1.73 m2.

In September, the National Institutes of Health announced that the SPRINT trial had been stopped early after patients who had a target systolic blood pressure of 120 mm Hg had significant reductions in MI, heart failure, stroke and the risk of death.

The full results were presented at the American Heart Association Scientific Sessions and simultaneously published in the New England Journal of Medicine in November. Adults who were randomized to a target of 120 mm Hg had a 25 percent lower relative risk of the primary composite outcome of MI, other acute coronary syndromes, stroke, heart failure or death from cardiovascular causes, 38 percent lower relative risk of heart failure, 43 percent lower relative risk of death from cardiovascular causes and 27 percent lower relative lower risk of death from any cause compared with those who had a target of 140 mm Hg.

In this analysis, the researchers evaluated the 2007 to 2008, 2009 to 2010, and 2010 to 2012 NHANES (National Health and Nutrition Examination Survey) data. In all, 16,260 participants met the eligibility criteria, which included participants who were at least 20 years old and had completed a medical evaluation at the NHANES mobile examination center. NHANES data was collected through interviews and medical evaluations.

The researchers said that 16.8 million (7.6 percent) U.S. adults from 2007 to 2012 met the SPRINT eligibility criteria, including 8.2 million (16.7 percent) of adults treated for hypertension and 8.6 million (5 percent) of adults without treated hypertension. They added that 20 percent of adults with hypertension and 2 percent of adults without hypertension met the eligibility criteria.

Of the adults who met the eligibility criteria, 6.6 million had a systolic blood pressure of 130 to 139 mm Hg and 10.2 million had a systolic blood pressure of 140 mm Hg or higher.

Further, older adults, males and non-Hispanic whites were more likely to meet the eligibility criteria.

The researchers said NHANES had a few limitations, including that it did not have information on whether patients had reduced left ventricular ejection fraction or subclinical cardiovascular disease and did not have information on other SPRINT exclusion criteria such as a history of medication nonadherence.

“Additional analyses are needed to assess the effect of more aggressive blood pressure lowering on neurological and renal function and quantify the medical and economic implications of implementing this more aggressive goal for blood pressure control across the population,” they wrote.