(Press-News.org) WINSTON-SALEM, N.C. – June 16, 2014 – For decades, common medical wisdom has been "the lower the better" in treating the approximately one in three people in this country who have high blood pressure. But does that approach result in reduced risk for dangerous heart events?
In a study published in the June 16 online edition of JAMA Internal Medicine, researchers at Wake Forest Baptist Medical Center found that lowering systolic blood pressure below 120 does not appear to provide additional benefit for patients. Systolic pressure is the top number in a standard blood pressure reading (e.g., 120/80).
"Frequently we treat patients' blood pressure to the lowest it will go, thinking that is what's best," said Carlos J. Rodriguez, M.D., associate professor of public health sciences at Wake Forest Baptist and lead author of the study.
"Our observational study found that treating to low pressures doesn't provide any benefit to patients with regard to reducing risk of dangerous heart events like heart attack, heart failure and stroke. This calls into question the notion that lower is better."
Previous studies had documented a progressive increase in heart disease risk as systolic blood pressure (SBP) rose above 115, but it was not known whether SBP lower than 120 in patients with hypertension (HTN) lowered the risk of heart failure, stroke and heart attack.
In this study, a total of 4,480 participants from the Atherosclerosis Risk in Communities Study were followed for 21 years for development of a cardiovascular event. Measurements of SBP were taken at baseline and at three-year intervals. SBP was categorized as elevated (140 or greater), standard (120 -139) or low (less than 120). The study findings were independent of baseline age, gender, diabetes status, body mass index, cholesterol level, smoking status and alcohol intake. A cardiovascular event was defined as heart failure, ischemic stroke, heart attack or death related to coronary heart disease.
The researchers found that among people with high blood pressure, once SBP is below 140, lowering it below 120 did not further reduce the risk of cardiovascular events.
"Our study found that the optimal blood pressure range for people with hypertension is120-139, which significantly reduces the risk of stroke, heart attack or heart failure," Rodriguez said. "These findings suggest that you don't need to go lower than that to have the benefits."
Rodriguez said that his study was not a clinical trial and its results need to be confirmed; noting that a large clinical trial under way called SPRINT should either confirm or refute the findings.
INFORMATION:
Funding for the study was provided by the National Heart, Lung, and Blood Institute grant award R01HL104199, and by contracts for the Atherosclerosis Risk in Communities Study.
Co-authors are: Katrina Swett, M.D., of Wake Forest Baptist; Sunil K. Agarwal, M.D., Johns Hopkins University; Aaron R. Folsom, M.D., University of Minnesota; Ervin R. Fox, M.D., University of Mississippi Medical Center; Laura R. Loehr, M.D., Wayne D. Rosamond, M.D., and Patricia P. Chang, M.D., of University of North Carolina at Chapel Hill; and Hanyu Ni, M.D., of National Heart, Lung, and Blood Institute.
Lower isn't necessarily better for people with high blood pressure
2014-06-16
ELSE PRESS RELEASES FROM THIS DATE:
Beta-blockers before coronary artery bypass grafting surgery not associated with better outcomes
2014-06-16
Bottom Line: Use of beta (β)-blockers in patients who have not had a recent heart attack but were undergoing nonemergency coronary artery bypass grafting (CABG) surgery was not associated with better outcomes.
Author: William Brinkman, M.D., of the Cardiopulmonary Research Science and Technology Institute, Dallas, and colleagues.
Background: The use of preoperative β-blockers has been associated with a reduction in perioperative mortality for patients undergoing CABG surgery in previous observational studies. Preoperative β-blocker therapy is a national ...
Intervention increased adherence to fecal occult blood testing for colorectal cancer screening
2014-06-16
Bottom Line: A multipart intervention increased adherence rates of annual fecal occult blood testing (FOBT) for colorectal cancer (CRC) screening in vulnerable populations.
Author: David W. Baker, M.D., M.P.H., of the Feinberg School of Medicine at Northwestern University, Chicago, and colleagues.
Background: The vast majority of CRC screening in the U.S. is by colonoscopy, although studies suggest that FOBT can achieve similar reductions in CRC mortality. Colorectal cancer screening rates are lower among Latinos and people living in poverty. Expanded use of FOBT ...
No adverse cognitive effects in kids breastfed by moms using antiepileptic drugs
2014-06-16
Bottom Line: Breastfeeding by mothers treated with antiepileptic drug (AED) therapy was not associated with adverse effects on cognitive function in children at 6 years.
Author: Kimford J. Meador, M.D., of Stanford University, California, and colleagues for the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study Group.
Background: Some concern has been raised that breastfeeding by mothers being treated with AED therapy may be harmful to the child because some AEDs can cause neuronal apoptosis (cell death) in immature animal brains.
How the Study Was ...
Majority of older breast cancer patients use hormone treatment
2014-06-16
WASHINGTON — One of the most comprehensive looks at the use of hormone therapy in women over 65 with non-metastatic breast cancer found some welcome news. Except for frail patients, most participants in the large study complied with their oncologists' recommendations to treat their estrogen-positive breast cancer with hormone therapy — either an aromatase inhibitor or tamoxifen. These drugs prevent tumors from using estrogen to fuel growth.
But the study, reported online June 16th in the Journal of Clinical Oncology, also found that non-white women were much more likely ...
Major surgery associated with increased risk of death or impairment in very-low-birth-weight infants
2014-06-16
Bottom Line: Very-low-birth-weight (VLBW) babies who undergo major surgery appear to have an increased risk of death or subsequent neurodevelopmental impairment (NDI).
Author: Frank H. Morriss, Jr., M.D., M.P.H., of the University of Iowa, Iowa City, and colleagues.
Background: Some animal studies suggest general anesthesia for surgery can increase the risk for neurocognitive or behavioral deficits. This has raised some concerns about exposing infants to general anesthesia for surgery.
How the Study Was Conducted: The authors examined the association between ...
Military personnel with concussive TBI caused by blast or nonblast event no difference in outcomes
2014-06-16
Bottom Line: Military personnel with concussive traumatic brain injury (TBI) caused by a blast or a nonblast-related event had similar outcomes, including headache severity and depression.
Author: Christine L. Mac Donald, Ph.D., of the Washington University School of Medicine, St. Louis, and colleagues.
Background: It has been estimated that in the U.S. military about 20 percent of the deployed force experienced a head injury in the wars in Iraq and Afghanistan. Of those injured, about 83 percent had a mild, uncomplicated TBI or concussion. Blast injuries were the ...
Outreach doubles colon cancer screening in low-income communities
2014-06-16
CHICAGO --- In low-income and minority communities where colonoscopies may be prohibitively expensive for many residents, less-invasive, more frequent testing combined with automated reminders, can yield dramatic improvements in colorectal cancer (CRC) screening rates, according to a new Northwestern Medicine® study.
The study found that community health center patients who received follow-up -– that is, outreach by mail, automated telephone and text messages, and calls by a health center staff member if no response was given in three months -- were more than twice as ...
Penn anesthesiologists identify top 5 practices that could be avoided
2014-06-16
(PHILADELPHIA) – A team of researchers led by Penn Medicine anesthesiologists have pinpointed the "top five" most common perioperative procedures that are supported by the least amount of clinical evidence, in an effort to direct providers to make more cost-effective treatment decisions. Their findings are published in the current issue of JAMA Internal Medicine.
The team surveyed anesthesiologists, many of them in academic practice, to identify the most common activities that should be questioned in the field, using practice parameters developed by the American Society ...
In military personnel, no difference between blast and nonblast-related concussions
2014-06-16
Explosions are the most common cause of traumatic brain injuries in veterans returning from Iraq and Afghanistan. A new study shows that military personnel with mild brain trauma related to such blasts had outcomes similar to those with mild brain injury from other causes, according to researchers at Washington University School of Medicine in St. Louis.
However, nearly 80 percent of patients in both categories of brain trauma suffered moderate to severe overall disability within a year after injury.
The analysis appears June 16 in JAMA Neurology.
"We are interested ...
How to prevent disparities in colon cancer screening
2014-06-16
SEATTLE—People living in poverty are less likely to be screened regularly for colorectal cancer—and more likely to develop the disease and die from it. How to end these disparities—and raise screening rates, lower disease rates, and prevent deaths? A promising way is to mail fecal immunochemical tests (a newer kind of stool test) to populations, Beverly B. Green, MD, MPH, and Gloria D. Coronado, PhD, wrote in the June 17 JAMA Internal Medicine.
Dr. Green is a Group Health physician and an associate investigator at Group Health Research Institute. Dr. Coronado is a senior ...