Less is More: New Guidelines Lower Systolic Blood Pressure Goal
Mary Brennan, DNP, AGACNP-BC, ANP, FAANP
Clinical Associate Professor
NYU Rory Meyers College of Nursing
Hypertension is the leading cause of death and disability. Lack of effective blood pressure control can lead to cardiovascular disease, heart failure, hemorrhagic and ischemic stroke, kidney failure, peripheral arterial disease, and cognitive decline. Recently, the American College of Cardiology/American Heart Association updated their guidelines to recommend a lower systolic blood pressure goal (SBP) of less than 130 mm Hg for adults at increased cardiovascular risk. The new guidelines emerged from a recent study finding lower systolic blood pressures were associated with significant declines in all-cause and cardiovascular mortality. Lower is better when it comes to systolic blood pressure, but how low should we go?
The study conducted by the SPRINT Research Group tested the hypothesis that systolic blood pressure (SBP) <120 mm Hg would prevent the development of hypertension-induced complications in people at increased cardiovascular risk. Participants were randomized to the routine SBP management <140 mm Hg or the intensive intervention target of <120 mm Hg.
To achieve target goals, people in the intervention target needed on average three anti-hypertensives compared to two in the standard group. The <120 mm Hg SPG group saw a reduction in all-cause and cardiovascular mortality but also had higher rates of adverse events such as hypotension, fainting, electrolyte abnormalities, and acute kidney injury or failure.
Currently, less than 50% of people treated for hypertension achieve an SBP goal of <140 mm Hg. How do providers help patients achieve an even more aggressive goal of <130 mm Hg?
Detection and treatment of blood pressure to target goals are critical for heart health. Healthcare professionals should make hypertension visible, monitoring at every clinical visit throughout the lifespan. Blood pressure measurements are often subject to error, and clinicians need to implement guideline-based recommendations to obtain accurate readings. Additionally, healthcare professionals need to encourage individuals to monitor their own blood pressure. Self-monitoring of blood pressure is associated with improved control, perhaps owing to increased awareness of the readings.
Once hypertension is detected, adherence to lifestyle interventions and anti-hypertensive agents must be emphasized. Many patients will require the addition of three or four standard anti-hypertensives to achieve lower targets. Carefully assessing patients for hypotension and other intolerable side effects is one of the safest strategies to reduce complications and ensure compliance.
In celebration of February as “Heart Month,” let’s make blood pressure numbers visible so we can help all individuals see and meet their heart-healthy blood pressure goals.
Group SR, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373:2103–16
RJ McManus, J Mant, MS Haque, et al. Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial
JAMA, 312 (2014), pp. 799-808