Blood pressure lowering keeps even more Australians alive longer

Millions more Australians may now benefit from better control of blood pressure, following the release of new research in the New England Journal of Medicine (NEJM).

Executive Director for The George Institute for Global Health, Australia, Professor Vlado Perkovic was asked to write the editorial for the research and said it was a game changer.

“There are very few treatments proven to reduce the risk of death among mostly healthy people, but lowering blood pressure to a reduced target level is now one of them,” Prof Perkovic said.

“The Systolic Blood Pressure Intervention (SPRINT) trial enrolled more than 9,000 people with blood pressure levels above 130 mm Hg who were at high risk of heart disease and stroke.

“It compared the effects of keeping levels below the currently recommended 140 mm Hg, to a much more intensive goal of 120 mm Hg or less.

“People treated to the lower target had the risk of cardiovascular events reduced by one quarter, and the risk of dying reduced by 27%.”

Professor Perkovic said the research changes everything when it comes to understanding and treating high blood pressure.

“Now, with this research, more people can be treated appropriately with lifestyle modification, and if they are at high risk, blood pressure lowering medicines, achieving a big reduction in their risk of death,” he said.

“Previously, one quarter of Australian adults had hypertension and were treated to a target of below 140 mm Hg.

“This research found that keeping blood pressure levels below 120 mm Hg in a much broader range of people, including many not previously treated, prevents death and cardiovascular events.

“It shows that millions more Australians can benefit from lowering blood pressure, including a large number who do not have hypertension.

“It also suggests the concept of hypertension is not useful, and instead that people at high risk of cardiovascular disease should be targeted for intensive blood pressure lowering treatment aiming for a target of 120 mmHg or less.

“Globally the numbers are even more staggering and growing, as billions of people have blood pressure levels above 130 mmHg, and a large proportion are at high cardiovascular risk.”

The NEJM study supports new research published in the Lancet last week by the George Institute, which shows Australians can prevent heart attacks and stroke with more intensive management of blood pressure.

Principal Director, Professor Stephen MacMahon, said the study, which was published in The Lancet, found intensive management gave patients greater protection than the current process.

“Previously guidelines recommended lowering blood pressure to 140 mm Hg, but we found that going beyond this had great benefits for patients,” Prof MacMahon said.

“This confirms a quarter of a century of our research, which has argued that the guideline-recommended goal of 140 mmHg is too high.

“We can reduce heart disease significantly and even save lives through intensive blood pressure lowering.”

The study, Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis found:

• The more intensive treatment group had their blood pressure lowered to 133/75 mm Hg, compared to 140/81 mm Hg
• This resulted in reductions of major cardiovascular events by 14%, heart attacks by 13% and strokes by 22%
• Blood pressure lowering had clear benefits even in patients with an initial blood pressure lower than 140 mm Hg.

Professor of Global Health at the Institute, Anthony Rodgers said it had taken far too long to get to this point.

“The George Institute for Global Health has been recommending these changes for many years,” Prof Rodgers said.

“It highlights the importance of evidence based practice as well as investing in healthcare delivery research.

“Research of this nature 10-15 years ago would have accelerated the development of better uses of blood pressure lowering medicines, so the benefits could reach Australia sooner.

“It’s pleasing to see the government make a funding commitment to research through the Medical Research Future Fund (MRFF), which can benefit all of us through these sorts of studies.”

Read Professor Vlado Perkovic's editorial in the New England Journal of Medicine.