Millions more American may need high blood pressure medications, study says

A new study finds that aggressive treatment of high blood pressure reduced the risk of death by 25%, a finding that could lead millions more Americans to take medications.

Doctors found big benefits when they gave patients medications that aimed to reduce their systolic blood pressure – the top number in a blood pressure reading – to 120 millimeters of mercury or less. Today, doctors aim to get most patients' systolic blood pressure below 140.

Reducing systolic blood pressure also reduced the risk of problems such as heart disease, heart failure and stroke by 30%, according to researchers from the National Institutes of Health.

"More intensive management of high blood pressure in people 50 years and older can save lives and reduce cardiovascular complications like strokes," said Gary Gibbons, director of the National Heart, Lung and Blood Institute, part of the NIH, which funded the trial. The study, the largest of its kind, included more than 9,300 people age 50 and over. Drug companies also donated two of the drugs used in the study.

Patients began the study with a blood pressure of about 140, taking an average of about two medications. Those who lowered their systolic blood pressure below 120 took an average of three medications.

About one in three Americans – around 70 million people – have high blood pressure, and only half of them have their blood pressure under control, Gibbons said. High blood pressure increases the risk of heart attacks, strokes, kidney disease and other serious problems. Doctors will continue to follow patients to see whether lowering blood pressure also reduces their risk of dementia, memory loss and kidney disease.

Doctors aren't yet recommending that more patients take blood pressure medication or that doctors change their practice, said Jackson Wright, a study leader and director of the clinical hypertension program at Case Western Reserve University in Cleveland. That's because these results are preliminary and haven't yet been published.

NIH researchers did not provide any details about how many lives were saved or the side effects of lowering blood pressure so dramatically.

"These results have not been peer-reviewed and they should be considered highly preliminary," said Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. "The medical community will not be able to evaluate whether to target lower blood pressure until we have the ability to analyze and review the full data set."

Doctors who announced the study urged people not to change their blood pressure medication without talking to their doctors first.

A board overseeing the welfare of patients in the study decided to end the trial early because the results were so strong, and the board considered it unethical to hide the findings from patients.

Groups such as the American Heart Association and American College of Cardiology will likely consider the trial results when deciding whether to revise their guidelines, said cardiologist Cam Patterson, chief operating officer at New York-Presbyterian Hospital/Weill Cornell Medical Center. The results could lead millions more people to take medications, he said.

"Many blood pressure medicines are relatively cheap and cost effective," said Patterson, who was not involved in the new study. "This might be a way to significantly reduce the consequences of high blood pressure and improve cardiovascular health without breaking the bank, for once."

Getting patients to take blood pressure medicines is always a challenge, Patterson said. High blood pressure is called the "silent killer" because it produces no symptoms. Because even people with dangerously high levels can feel fine, some don't see the need to take their medications as directed. Other patients stop taking their medications because of side effects.

There are many kinds of blood pressure drugs and each has different side effects, Patterson said. Some common side effects include a cough, diarrhea or constipation, headaches, nausea, vomiting, skin rashes, weight gain or weight loss, lack of energy, dizziness or light-headedness and feeling nervous, tired, weak or drowsy, according to the NIH.

Beyond medications, people also can lower their blood pressure by avoiding tobacco, reducing the amount of salt in the diet, eating more fruits and vegetables, losing weight and exercising, according to the American Heart Association. Many people find it hard to make such lifestyle changes.

"Establishing guidelines is one thing," Patterson said. "Getting patients to (their blood pressure) target is another."