Blood Pressure checking, your blood pressure, falling blood pressure

How low should your blood pressure go? Doctors have been debating this question for decades. While people with naturally low blood pressure appear to live longer, medications have drawbacks. In addition, older people appear to be more vulnerable to dementia when their blood pressure is too low.

In 2014, experts raised target blood pressure for older Americans. But the SPRINT trial demonstrated that people with lower systolic blood pressures were less likely to have heart attacks. As a result, we are left wondering what is the proper balance between the benefits of blood pressure control and the risks of overmedication?

Determining the Best Level for Blood Pressure:

A new analysis published in JAMA Cardiology demonstrates benefits from lower blood pressure than is currently seen as the target. The researchers evaluated data from 42 randomized clinical trials. All together, those studies included 144,220 patients as participants.

Patients whose systolic blood pressure was between 120 and 124 were only one-third as likely to suffer cardiovascular complications. That is in comparison to people whose systolic blood pressure was at 160 or higher. In addition, they were only about half as likely to die during the study as those with higher pressure.

Even comparisons with people whose systolic blood pressure landed between 130 and 134 showed advantages for those with blood pressure between 120 and 124.

What Is Systolic Blood Pressure?

Systolic blood pressure measures the force the heart exerts while contracting. It’s the higher of the two numbers and is usually first when blood pressure is expressed as, for instance, 120 over 80 (120/80). In this example, 80 is the diastolic blood pressure.

The scientists concluded that most people are at the lowest risk for heart attacks, strokes and death when their systolic blood pressure is between 120 and 124.

Bundy et al, JAMA Cardiology, online May 31, 2017

You and your doctor may need to discuss your risks. That way, you can figure out your blood pressure target. You want to balance your risk of cardiovascular complications against the risk of reactions to antihypertensive medicines. You may wish to read our Guide to Blood Pressure Treatment as you prepare for that conversation.

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  1. Emily

    When I first read about this study, I found it suspicious that they stopped it early supposedly because the benefits had become so obvious. And as it turns out, I’m not alone. Richard Amerling, MD (board certified by the American Board of Internal Medicine for Internal Medicine and Nephrology and president of the Association of American Physicians and Surgeons) commented in an article about this study that he found it suspicious as well, that this had the effect of downplaying the side-effects that would undoubtedly have developed the longer the study continued. He also pointed out that this was not a “blinded” study, which is considered necessary to eliminate investigator bias. Moreover, he pointed out, the researchers used a composite outcome, not a single endpoint, a “a gimmick,” he said to get a ‘statistically significant’ result.”

    I’ll quote his other objections to the study in full: “Fifth, and perhaps most important, the intensive treatment group achieved the composite endpoint at a rate of 1.65 percent per year, as opposed to 2.19 percent in the standard treatment arm. Thus, while the Times reported that the intensively treated patients ‘had their risk of heart attacks, heart failure, and strokes reduced by a third,’ the actual risk reduction was 0.54 percent. With the large number of patients enrolled (more than 9,000), this achieved statistical significance.

    “Sixth, serious side effects such as kidney failure, low blood pressure, electrolyte disturbances, and fainting, were more common in the intensively treated patients.

    “When the actual risk reduction is so small, the ‘number needed to treat’ to prevent one bad outcome necessarily becomes large. The authors report that to prevent one death from cardiovascular causes, 172 patients would need to be treated over three years. And 171 of these would be subjected to myriad side effects without benefit.”

    His conclusion: “Not a great model for health. The SPRINT study is a classic example of so-called ‘evidence-based medicine.’ This flawed trial will no doubt be used to promote more aggressive treatment of hypertension in general, and will almost certainly lead to many more complications, and diminished quality of life, with little or no benefit.”

    Unfortunately, with so much money to be made in selling people drugs that they have to take for the rest of their lives, I’m afraid that this kind of flawed “evidence” is going to continue to be trumpeted. My husband tried every class of blood pressure medication trying to get his numbers to where the medical establishment wanted them to be, and ended up a seriously diminished quality of life from side-effects, which took six months to recover from. We’re lucky because some people never recover. It would be nice (but will never happen, unfortunately) if we could get the profit motive out of pharmaceutical medicine so that we can get some truly unbiased research results.

  2. Leise
    Los Angeles

    Thank you for your objective presentation of this issue.If my blood pressure falls below 134 I am like a zombie, with no energy to spare, whereas 140 is optimal for me. That blood pressure studies and recommendations are obsessed with cardiac effects and ignore quality of life impact is unfortunate. Ideal blood pressure is not one-size-fits-all, and can best be determined and sustained by working closely with one’s doctor.

  3. Rick

    Lies lies and more lies, if you are suffering from arteriosclerosis your PB is naturally high in order to feed oxygen to the periphery of your body which includes your brain. Most people over the age of 50 have occluded arteries and the reason for the higher BP is that you body is compensating for the occlusions in order to maintain homeostasis.Besides if you want to remain pain free people use NSAID’s which for many raise their BP as much as 80 points in a matter of minutes. Also remember this cholesterol is not the enemy its the pharmaceuticals you are prescribed to lower your cholesterol that have and will continue to do more damage than the actual cholesterol. I was told I needed to take statins from a cardiologist that had not even tested my cholesterol even though my GP had told me my cholesterol was perfect and the cardiologist told me my heart was perfect but in his words I was non compliant

  4. Everett
    Rocheport, MO

    I have taken Valsartan/HCTZ 100MG/25MG for several years prescribed by a previous doctor for blood pressure reading of >140 systolic (don’t remember diastolic). I retired, moved, changed diet, increased exercise and got a new doctor where I now live. BP meds were left the same.

    I had some issues of light headedness and dizziness when getting up. My blood pressure was in the range of 110/62 to 120/66 for about a week of daily monitoring. Pulse was in range of 45 to 55 beats per minute. Called doctor and sent the data and he agreed to cutting the pills in half and continuing my monitoring. After about two weeks things are somewhat stabilize at 115/60 to 122/70 with pulse in the 60’s. (My pulse rate has been low all of my life.) Do the current BP and pulse rates seem reasonable or are additional changes needed. (Have not gotten back with doctor yet.) Light and dizziness virtually gone.

  5. Marcia

    I think when they lowered the parameters of normal blood pressure in this country, the pharmaceutical companies automatically gained 3 million new customers.

  6. Jackie
    Salem, Ohio

    I take a Beta Blocker, every morning. when I take my pill, my blood pressure bottoms out to 90/69,but when I take my evening pill, it doesn’t do that. what could be causing that.

  7. Glenn
    North Carolina

    I’ve done neuropsychological testing on older people for over 37 years. And those with b/p’s like 130/90 have more problems such as strokes that arise. I can’t recall ever seeing a stroke patient with a b/p of ~120/80.

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