Local Doctors: Blood Pressure Study Big, Not Universial

Nov 18, 2015

ECU Physicians nurse Mary Pinion, left, checks the blood pressure of SPRINT trial patient Anthony Thomas as Dr. James Powell looks on. SPRINT is a nationwide blood pressure study involving Brody School of Medicine faculty and patients.
Credit Photo by Gretchen Baugh, ECU

Is 120 the new 140? According to initial results from a nationwide blood pressure study, conducted in part by East Carolina University, it may be for some. 

One third of all Americans are hypertensive, but that rate is higher here in eastern North Carolina.  Division Chief of General Internal Medicine at ECU Brody School of Medicine, Dr. James Powell,

“Despite a lot of effort to try help a lot of folks, and we’ve helped a lot of folks through the years, Eastern North Carolina still has a very high penetration of people with high blood pressure.”

According to a 2013 study by the North Carolina State Center for Health Statistics across North Carolina, 38.9 percent of adults in Eastern North Carolina have been told they have hypertension.  High blood pressure increases your risk for stroke, heart attacks, heart failure and sudden cardiac death. For this reason, a national study was recently undertaken with major help from East Carolina University in Greenville.

The Systolic Blood Pressure Intervention Trial, or SPRINT, sponsored by the National Institutes of Health, began in 2009, lasting more than 60 months, and included more than 9,000 participants over the age of 50 with increased risk of heart or kidney disease.  The takeaway supports more aggressive treatment of high blood pressure to achieve a systolic rate of 120 or less to decrease the risk of heart attacks, strokes and heart failure.

The systolic rate is the top number of a blood pressure reading and measures the pressure in arteries when your heart beats. That number helps determine one’s risk for cardiovascular disease.

"If you think about it, the top number is your higher end in how much pressure is being exerted on your arteries, how much pressure is being exerted on your kidneys, on your eyes, on all of your organs.  And then the bottom number, if it stays consistently high, it's just a relentless pressure on your organs, that's a significant issue with it."

East Carolina University’s Brody School of Medicine played a major role in the study monitoring the second largest cohort within the trial.  250 participants were randomly divided into two groups.  One group aimed for a systolic blood pressure of 140 with the help of two medications.  The other group averaged three medications to lower their blood pressure to 120.  Researchers say this intensive treatment reduced the rate of heart attack, stokes and heart failure by a third, and the risk of death by almost 25%.

Federal health officials say the SPRINT study “was halted early when an analysis indicated the benefits were clear.” The study officially ended in September, though it wasn’t scheduled to end until 2016.

This isn’t the first time health officials have taken a look at the systolic rate’s effect on at-risk patients. A similar study was done for diabetics in the last decade and one of the prerequisites for acceptance in the trial was not being diagnosed with diabetes, though Dr. Powell said some participants were diagnosed during the course of the study.

“We needed to find out for nondiabetics, for folks who had heart disease…we needed to answer that question or other folks…if your diabetic or if you’re non-diabetic, are your actually goals the same, because some people believe they’re not, and so this is another study that’s well done, with over 9,000 patients, that will provide us with more evidence so we can answer the questions we need to answer.”

Though researchers say this could change the way physicians treat their patients’ hearts, it may not be a silver bullet for those living in areas that struggle with widespread and severe high blood pressure – areas like Eastern North Carolina.  Dr. Powell says a number of factors contribute to Eastern North Carolinian’s struggle to keep blood pressure low, including poor diet, lack of exercise, infrequent checkups, and a prominent, rural way of life that is, often, stressful – something with which Dr. Powell sympathizes being the son of a farmer.

“You see that over time, for some people, certainly the stress of every year needing to make a crop to pay your bill, that’s hard. But then, also, as some of farming has changed from when daddy was growing up and he had to go out there and chop peanuts every day to now having a machine do that, it’s different because some people ride on a tractor all day aren’t as physically active as they used to be, and so you see some of that, but you can see just the stress and strain of the long hours, especially this time of year, it rains so much for a couple weeks and everybody got behind, and now they’re trying to make it up and trying to save what they got out there they’re going to work. I’m used to hearing the peanut pickers run all night long, they’re trying to save their crop and trying to paid their bills the year.”

But while the trial’s findings have found its way to major news outlets around the world, it more than likely won’t affect large chunks of the population. Internal medicine physician and Vice President of Coastal Carolina Health Care, PA, Ronald A. Preston says the study’s findings, while interesting, come at odds with a report from the Joint National Committee of The Journal of American Medicine Association, or JNC8. Released in 2014, it states a systolic rate of 150 for adults age 60 and over is still acceptable for the general population.

Results of research conducted in part at East Carolina University could affect treatment of hypertension across the United States.
Credit Photo by Gretchen Baugh, ECU

The “aggressive treatment” called for by the recent SPRINT study focuses primarily on those at risk with heart and kidney failure.  Dr. Preston wants to remind those who saw banner headlines about the SPRINT findings that the research doesn’t apply to everyone, and could have adverse repercussions for some.

“In JNC8 they changed it to 150 mmHg for people 60 and older would be allowable with the reasoning being that if you push blood pressure too low in people as they get older, then you cause some people to faint and do bad things when they faint like break hips and things like that sort of thing.”

Dr. Preston believes no matter your target systolic rate, the best course of action to take with your physician is transparency about the medications you’re taking, or aren’t taking.  Dr. Preston says sometimes patients don’t take their prescriptions because of side effects.

“What often happens is people have a side effect from medication and they just secretly don’t take it, and then the doctor’s scratching his head, wondering why the blood pressure won’t come down. And the patient doesn’t want to own up to not taking it. So, I think, just be honest with your doctor and express your concerns.

Though the trial’s finished, some physicians say there’s still work to be done and more factors to test.  Dr. Powell said despite his role as lead investigator, he’s not prepared to tell his patients, across the board, that their new systolic rate target is 120. He wants to examine how lower blood pressure will affect cognitive function over time.  He also believes it’s important to remember not all hearts are the same and a healthy target for one may not be a healthy target for another.

I want to see all the data, even though I’m involved in it. I still want to see all the data for myself, and I think, ultimately, what we’re going to find is while some people we may try to drive lower, I don’t know if we’re going to try to drive everybody lower because some people can’t tolerate it. And that’s one of the things I think we’re going to see in this is that people who have a lot of chronic illness, as you try to drop their blood pressure lower and lower they may not feel very good, and we want people to have fewer heart attacks and strokes, but we’d like for them to feel good, too. And so we’re going to have to find that balance with some people about where’s their blood pressure and how they’re feeling.”

According to the Centers for Disease Control and the American Heart Association, a normal blood pressure systolic number is 120 or less.  A systolic reading of 140 or more is indicative of hypertension.

Credit American Heart Association

For more information on the SPRINT study, go to https://www.sprinttrial.org/public/dspHome.cfm