If you have high blood pressure, what should your goal for your blood pressure be? That is an important question, because controlling your high blood pressure is the most powerful thing you can do to treat vascular disease and prevent heart attacks and strokes. High blood pressure is the leading risk factor, among 67 studied, for earlier death and years of life lost.
Most authorities point to a goal of 140/90 and even that target is achieved by a minority of patients. The number of people with a diagnosis of high blood pressure who have their blood pressure controlled to less than 140/90 is only 44% in the United States. That is fine if your problem is only high blood pressure and you are otherwise healthy. Most people with hypertension are not like that, and their blood pressure target should be 130/80. That is harder to achieve.
The patients with type 2 diabetes who experienced the greatest reductions in death, heart attack, stroke, and dialysis had a blood pressure goal of 130/80. They started the study with a top number on their blood pressure well over 140 and they ended the study period with an average top number of about 130. These patients that were more aggressively treated had one fourth as many heart attacks and one fifth as many strokes. That is why getting it right is so important.
The SPRINT trial studied this issue in patients who did not have diabetes. It compared a goal of 120 for the top number vs 140 in patients who had high risk of heart attacks. These patients had cardiovascular diseases other than stroke; chronic kidney disease; a high risk score; or an age of 75 years or older. The mean top blood pressure achieved pressure was 121 in the intensive-treatment group and 136 in the standard-treatment group. This difference in blood pressure resulted in the intensive-treatment group having lower rates of several other important outcomes, including heart failure (38% lower relative risk), death from cardiovascular causes (43% lower relative risk), and death from any cause (27% lower relative risk). Achieving lower blood pressure is highly protective, even in patients over 75 years old.
These reductions in risk are very important, and if you have high blood pressure and a risk of heart attack, stroke, or chronic kidney disease, YOUR goal should be a blood pressure of 130/80 or less. I have worked with groups of doctors to achieve these lower blood pressure readings and they frequently object to being held to this standard. They say, “why should I be held to a standard that I have no control over? I make the right recommendations and the patients don’t follow them.” That often results in a higher, less effective blood pressure target as the goal. They are also worried about aggressive blood pressure lowering in older patients because of the risk of falls if the pressure drops too much when the patient stands. These are the people that a lower blood pressure helps the most. The higher the risk, the more protection blood pressure lowering provides. Age is the most powerful risk factor for heart attack and stroke. Certain drugs like prazosin and diuretics make a pressure drop when standing more likely. We avoid those risks by avoiding drugs like prazosin and using a protocol of specific drugs including medications like lisinopril or losartan, eplerenone, amlodipine, and a diuretic if needed. Using multiple drugs in smaller doses causes fewer side effects. It is possible to achieve lower blood pressure safely and with fewer sides effects when best practice choices are used. Be sure you achieve a safe blood pressure.
Thank you.
Hello again. Based on your previous posts, your definition of diabetic appears to be an A1C of 5.7 or above, correct? I am basing this on your view that the current range labeled prediabetic should in fact be correctly interpreted as diabetic. Is this a misstatement of your views?