New Guidelines and Recommendations for Managing Hypertension in 50 Plus Age Group

• Systolic Blood Pressure Intervention Trial (SPRINT) conducted by The National Institute of Health (NIH) studied the effect of blood pressure on heart disease, kidney disease, stroke and mental decline.
• High blood pressure is a major health concern in the U.S.
• Based on SPRINT, there are new recommendations for hypertension management.

Hypertension is known as a 'silent killer' as the symptoms of the condition are not easily detected but it could lead to an increased risk of cardiovascular disease, kidney disease, diabetes and mental decline such as loss in memory. The World Hypertension day is celebrated to increase awareness about this disease condition and to promote better management. A new study has found that hypertension should be more aggressively treated, than was thought before, to aid in better management.

The Study - SPRINT

Systolic Blood Pressure Intervention Trial (SPRINT) was conducted by the National Institute of Health(NIH) to study the effect of blood pressure on heart disease, kidney disease, stroke and mental decline due to age. The study included nearly 9300 participants and began in September 2009. The study participants were over 50 years of age and were recruited from medical centers across U.S and Puerto Rico.

The intervention that was used in the study includes blood pressure medication that was administered carefully to bring the blood pressure down to the required level.

The Initial Phase of the Study Found That:

Targeting and maintaining a lower blood pressure of 120mm/Hg lowered risk of cardiovascular disease, kidney disease, stroke and mental decline a lot better than previously recommended level of 140 mm/Hg.

Maintaining patient blood pressure at 120 mm/Hg resulted in reduction of risk of:

• Heart failure, heart attack and stroke by a third
• Death by a quarter

Dr. Lawrence Fine, Chief of Clinical Applications and Prevention Branch (NHLBI) had this to say about the study "Our results provide important evidence that treating blood pressure to a lower goal in older or high-risk patients can be beneficial and yield better health results overall, but patients should talk to their doctor to determine whether this lower goal is best for their individual care."

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Previous Recommendation for Blood Pressure Management:

The earlier clinical guidelinesthat dictated the management of hypertension stated that

• Blood pressure of healthy adults should be maintained at 140mm/Hg
• Blood pressure for patients at risk of kidney disease should be 130 mm/Hg

Significance of High Blood Pressure on Health:

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According to the Center for Disease Control (CDC)

• Nearly 1 in 3 adults in the U.S has hypertension
• One billion people across the world suffer from hypertension with two thirds from developing countries
• The leading cause of cardiovascular disease and premature death worldwide is due to hypertension.
• There is a higher risk of developing symptoms of diabetes among people with hypertension.
• According to WHO, by 2025, 1. 56 billion adults will suffer from hypertension worldwide.

In India, according to a study conducted by Raghupathy Anchala and colleagues

• 25% rural and 33% urban Indians were hypertensive
• Only 25% of rural Indians with hypertension receive treatment
• Only 38% of urban Indians with hypertension receive treatment

The high prevalence of hypertension and the associated risk of cardiovascular disease, kidney disease, diabetes or mental disabilities encourages research into better treatment modalities. The SPRINT study is one such study that was aimed at better control of hypertension and prevention of associated diseases.

Therapy for Hypertension

Clinical management guidelines in the U.S and Canada recommend

For First Line of Defense:

• Angiotensin-converting enzyme (ACE) inhibitor
• Angiotensin receptor blocker (ARB)
• Calcium channel blocker (CCB)

Diuretics may also be given to patients as a second line of defense.

The therapy for hypertension should include the latest recommendation based on the SPRINT study that blood pressure should be maintained at 120/80 mm/Hg for better care and lower risk of associated diseases. This requires more aggressive treatment and better monitoring.

References:

1. Systolic Blood Pressure Intervention Trial
   https://www.sprinttrial.org/public/dspHome.cfm
2. New Recommendations for Managing Hypertension
   http://today.uconn.edu/2016/02/new-recommendations-for-managing-hypertension/
3. Landmark NIH study shows intensive blood pressure management may save lives
   http://www.nhlbi.nih.gov/news/press-releases/2015/landmark-nih-study-shows-intensive-blood-pressure-management-may-save-lives
4. QUICK FACTS on hypertension & high blood pressure
   http://www.world-heart-federation.org/heart-facts/fact-sheets/cardiovascular-disease-risk-factors/quick-facts-on-hypertension-high-blood-pressure/
5. High Blood Pressure Facts
   http://www.cdc.gov/bloodpressure/facts.htm
6. Hypertension in India
   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011565/

Source-Medindia