U of U Health Research Supports Alternative Approach to Controlling Hypertension

Learn about this research and more at the upcoming Hypertension Symposium on Sept. 20, 2017, in the Eccles Institute of Human Genetics auditorium. See website for details.

One in three Americans have high blood pressure, or hypertension, increasing their risk for serious medical complications like heart disease and stroke. A series of studies drawing on the expertise of University of Utah Health clinicians and scientists are causing medical providers to reevaluate conventional approaches to treating hypertension. Results support decreasing the target blood pressure of high-risk patients below standard guidelines.

The health benefits of lowering systolic blood pressure below the standard target of 140 mmHg stems from a 2015 study published in the New England Journal of Medicine (NEJM). The investigation showed that lowering the goal to less than 120 mmHg decreased risk for heart attack, heart failure, and stroke by a quarter, and of death by nearly a third.

Implementing this intervention could prevent 100,000 deaths each year and provide health benefits to at least 17 million Americans, according to research by Adam Bress, PharmD, assistant professor of Population Health Sciences.

“The positive results took most investigators by surprise, and the strong benefits of treatment seem to outweigh the risks,” says Alfred Cheung, MD, chief of Nephrology & Hypertension who led a subset of the 100 sites in the national clinical trial, called SPRINT (Systolic Blood Pressure Intervention Trial).

Risks mainly stem from the three to four anti-hypertensive medications needed to achieve the lower blood pressure goal. The most common side effects are light-headedness and fatigue. Treatment can also negatively impact kidney function, according to research by nephrologist Srinivasan Beddhu, MD.

Yet, two recent NEJM investigations show that the tradeoffs are worth it – both in terms of health-related quality of life and financial costs.

One worry was that the new approach could impose a financial burden that overwhelms an already strained healthcare system. But advanced computer modeling methods developed by Brandon Bellows, PharmD, research assistant professor in Pharmacotherapy and research fellow Natalie Ruiz-Negron, PharmD, showed that intensive blood pressure control is of high value.

The health benefits gained over the long term outweighed the added costs of treatment, including from more visits to healthcare providers, medications, and lab tests. Analyses even accounted for the costly possibility of being hospitalized from side effects.

“Collectively, these results provide strong evidence that intensive control is a high value investment and worth considering in high-risk patients,” says Bress.

Mounting evidence also supports that benefits of treatment may extend beyond the small subset of patients examined in the original SPRINT clinical trial. SPRINT examined 9,300 participants age 50 years or older who were at increased risk for cardiovascular disease, had a systolic blood pressure of at least 130 mmHg, and did not have diabetes or a history of stroke. Now, it is becoming evident  that a broader set of patients, including those with prediabetes and chronic kidney disease, and frail, older adults in poor health, also reap health benefits that outweigh the risks.

Just as important, patients report tolerating intensive treatment as well as standard treatment.

“The reason I’m excited about this is the implications for public health,” says SPRINT investigator Mark Supiano, MD, chief of Geriatrics and director of the VA Salt Lake City Geriatric Research, Education, and Clinical Center. “There are millions of people age 75 and older who could potentially benefit. It’s a large number and we need to pay attention to it.”

Despite accumulating data, the verdict is not yet in. Longer-term studies are evaluating additional outcomes including effects of the intensive blood pressure control on cognition. After assessing those results, it is up to medical communities to decide whether, and how, to incorporate the new approach into medical practice guidelines.

“Medical experts are going to need to decide how far outside the SPRINT inclusion criteria to go,” says Rachel Hess, MD, MS, director of the Health System & Innovation Research program.

At its most extreme interpretation, should the 30 percent of American adults with hypertension aim for the lower blood pressure goal? “It’s going to be a tough decision,” she says.

U of U Health SPRINT investigators include: Srinivasan Beddhu, Alfred Cheung, Molly Conroy, and Mark Supiano (Internal Medicine), Brandon Bellows and Natalie Ruiz-Negron (Pharmacotherapy), Adam Bress and Rachel Hess (Population Health Sciences).

The research was supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001067. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.