Patients Report Few Side Effects from Aggressive Blood Pressure Control

By Gene Emery

NEW YORK (Reuters Health) - Patients subjected to aggressive blood pressure (BP) control report few side effects and little difference in quality of life compared to those whose treatment is less intensive, according to a new analysis.

The findings are an outgrowth of the large SPRINT study, whose authors reported nearly two years ago that the risk of a cardiovascular event was 25% lower if the systolic target of BP control was 120 mm Hg instead of 140 mm Hg.

Despite that improvement, many doctors have been reluctant to push for stricter BP control in their patients out of fear that the side effects would be too cumbersome, the chief author, Dr. Dan Berlowitz of the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts, told Reuters Health by phone.

The new analysis, in the August 24 New England Journal of Medicine, "is addressing this concern of whether intensive therapy makes people feel miserable - that they might have dizziness, fatigue and depression," he said. "When you look at the data, that's not what people were complaining about. But it's part of a careful, active management strategy."

Volunteers in the intensive-treatment group needed, on average, one additional antihypertensive medicine, although over half were already taking two or three antihypertensive drugs. None were diabetic or had a history of stroke.

The 9,361 participants were surveyed for as long as three years using several scales to see if the extra-aggressive therapy made a difference in their day-to-day lives. They found it did not.

Compared with patients on standard treatment, people in the intensive-therapy group scored the same on measures of physical and mental health.

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Patients who had more preexisting medical conditions reacted similarly whether they were getting standard or aggressive BP control. And any adverse effects of aggressive therapy did not reduce patient-reported adherence to treatment.

In the intensive-treatment group, 88.6% reported being satisfied or very satisfied with their BP care; the rate was 88.2% with standard care. In addition, 35.0% in the aggressive-care group reported an improvement in satisfaction versus 33.7% with standard care.

"The dogma is it will not be well tolerated. But we looked at every possible subgroup, including comorbidity and frailty," Dr. Berlowitz said. "And in whatever subgroup we were looking at, there was no difference between intensive and standard therapy."

That concern was one reason the SPRINT results didn't prompt a change in guidelines from the American College of Physicians, he said, admitting being "perhaps a little surprised" at how well more-aggressive treatment was tolerated.

"There's a belief that as people get older and frailer, they can't tolerate medications used to treat hypertension," said Dr. Berlowitz. "Yet when you look at the clinical trials, the concerns just don't seem to pan out."

Thus, patients should ask their doctors about the lower threshold of 120 mm Hg and whether it is appropriate, he said.

A companion article in the journal concludes that aggressive BP management not only prevents cardiovascular problems, but it's also cost-effective for the healthcare system.

SOURCE: https://bit.ly/2xtgbuL and https://bit.ly/2xtbNfs

N Engl J Med 2017.

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