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Lower Blood Pressure Could Save Your Life But at What Cost?

The SPRINT study suggests everyone should get blood pressure below 120. What are the downsides to lower blood pressure? Can blood pressure go too low?
Lower Blood Pressure Could Save Your Life But at What Cost?
Hypertension BP

Doctors have been debating the pros and cons of aggressive blood pressure treatment for decades. A comprehensive analysis of all prior well-controlled blood pressure trials by the independent Cochrane Collaboration concluded that:

“Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality [death] or morbidity [disease] in RCTs [randomized controlled trials].”

You can read more details about this Cochrane analysis by clicking on this link to our original article, “Hypertension Heresy: Are We Overtreating High Blood Pressure?”

Contradicting the Cochrane:

A large new study called SPRINT (Systolic blood PRessure INtervention Trial) contradicts the Cochrane analysis of other randomized controlled trials. In fact, the researchers overseeing the SPRINT study decided to stop their investigation prematurely. That’s because the initial lower blood pressure results seemed so promising that the scientists thought it would be unethical to delay publicizing the findings.

This federally funded study was designed to answer the question:

“Will lower blood pressure reduce the risk of heart and kidney diseases, stroke, or age-related declines in memory and thinking?”

The investigators recruited 9,300 American adults over 50 years old and randomly assigned them to one of two targets for systolic blood pressure. That is the first and higher number in a typical blood pressure reading of, say, 120/80. It measures the pressure on the blood vessels while the heart is contracting to squeeze blood through them.

Half of these people were assigned to get their systolic pressure below 140, while the other half were to get it under 120, long considered a “normal” level for systolic blood pressure. The study was supposed to run through 2017, but it has just been cut short because the results seemed so clear.

SPRINT Results:

For those in the intense blood pressure control arm, getting systolic blood pressure under 120 reduced cardiovascular complications by one third and cut their risk of dying during the study by 25 percent. The results reinforce the aggressive approach to blood pressure control that many physicians favor.

So far, all the American public knows is that the study was stopped prematurely and that the lower blood pressure the better. What has not yet been revealed are the actual data. We will have to wait several months before the full data from the SPRINT trial are published.

The Downsides of Aggressive Blood Pressure Treatment:

As long as treatment does not produce serious side effects, it may make sense to aim for a systolic blood pressure of 120 or lower. By the way, the investigators don’t yet know whether getting blood pressure that low among older people will help or harm mental function.

A study published earlier this year from Italy (JAMA Internal Medicine, online, March 2, 2015) suggested that moderation in blood pressure treatment might be prudent. In this research, investigators observed 172 elderly Italians who were attending memory clinics. Two-thirds had dementia, while about a third had mild cognitive impairment. Around 70 percent were taking drugs to lower their blood pressure.

Twenty-four hour blood pressure monitoring revealed that those with the lowest systolic pressure (at or under 128 mm Hg) had a bigger drop in their performance on a cognitive function test than those whose systolic pressure ran higher.

The investigators concluded:

“The present study adds information about older outpatients with MCI [mild cognitive impairment] and dementia, suggesting that strict control of SBP [systolic blood pressure] may negatively affect cognition, with daytime SPBs of 130 to 145 mm Hg being the most appropriate therapeutic targets.”

You can read more about this study in our article, Aggressive Blood Pressure Control Leads to Mental Decline.”

Non-Drug Approaches to Controlling Blood Pressure:

Before millions of senior citizens are prescribed two, three or more medications to drastically lower their systolic blood pressure below 120, people need to seriously consider the benefits of non-drug approaches.

Peggy from Ocean Park, Washington shared this approach:

“I have been juicing raw beets, one a day, for two months and have lowered my BP [blood pressure]. I drink from 1/4 cup to1/2 cup a day, depending on the size of the beet.

“I took hydrochlorothiazide [HCTZ]  for 10 years and had a bad rash as a side effect. I’ve been off meds for 1 1/2 years and am doing fine. I lost weight and am more active. My doctor has been helping me.”

Losing even a little weight, becoming more fit through exercise, learning to reduce stress and eating a diet that features vegetables and fruits can all be helpful. The DASH (Dietary Approaches to Stop Hypertension) and Mediterranean diets both have solid scientific data to back up their benefits. Beets raise levels of nitric oxide in the body. This compound makes blood vessels more flexible and has been shown to lower blood pressure in scientific studies.

To learn more details about the both the DASH diet and the Mediterranean diet (not as simple as a slab of salmon and some veggies) you might want to consult our book, The People’s Pharmacy Quick & Handy Home Remedies. We provide lists of antioxidant-rich vegetables and fruits that are less likely to raise blood sugar and legumes that can provide high-quality protein.

Find out more information about how beet juice can lower blood pressure in Quick & Handy Home Remedies. You will also discover some of our favorite recipes that will assist you in following these diets without feeling deprived.

How to Take Medications Wisely:

When lifestyle change is not enough, medications can make a difference. But it is always essential to weigh the pros and cons of drugs. One of the most common complaints of older people taking blood pressure medicines is dizziness. In some cases this can lead to unsteadiness and falls. A broken hip is a catastrophe that can lead to permanent disability or early death.

Anyone who experiences side effects such as dry mouth, abnormal vision, cough, dizziness, erectile dysfunction, mental fogginess or fatigue (to name just a few adverse drug reactions associated with blood pressure medicine) should consult a doctor promptly. It should be possible to manage hypertension without suffering unacceptable side effects.

Monitor Your BP Regularly:

You should get in the habit of measuring your own blood pressure. Even those under 50 can benefit from better blood pressure control. Getting regular feedback on blood pressure can help provide motivation for meeting exercise and diet goals.

We have written about various ways to control hypertension, including many sorts of medications, in our Guide to Blood Pressure Treatment. You will also learn about common mistakes people (including health professionals) make when taking blood pressure. Accurate readings are much more important now that many health professionals will be pushing for lower blood pressure readings. Tips for taking blood pressure correctly are found in the Guide.

Share your own thoughts about the new recommendation to get systolic blood pressure under 120 in the comment section below and please vote on this article at the top of the page.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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