Wake Forest medical school study finds constant maintenance key to benefiting from lower blood pressure
The latest report on a 13-year blood pressure management study by Wake Forest University School of Medicine provided additional evidence that continuing maintenance remains a key to reducing cardiovascular disease.
In 2009, the medical school was named as the coordinating center for the $114 million study by the National Institutes of Health that began in 2010 and lasted for nine years. The medical school also has served as a clinical center for the Southeast, which has had about 1,000 local participants.
Overall, the Systolic Blood Pressure Intervention Trial, known by acronym SPRINT, was conducted in 102 clinical sites in the U.S. and Puerto Rice involving more than 9,300 participates ages 50 and older.
The goal was determining whether maintaining blood pressure at levels lower than current recommendations can further reduce the risk of cardiovascular and kidney diseases, or age-related cognitive decline.
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“Nearly one out of every three Americans is affected by high blood pressure,” said David Reboussin, a professor of biostatistical sciences in the Division of Public Health Sciences at WFU’s medical school.
The latest report determined that “while intensive blood pressure control was beneficial to SPRINT participants’ health during the trial, the benefits for cardiovascular mortality went away after approximately two years when protocols for blood pressure management were no longer being followed.”
The latest findings are published online in JAMA Cardiology.
“We wanted to examine the long-term effect of SPRINT’s intensive treatment,” said Nicholas Pajewski, associate professor of biostatistics and data science at Wake Forest’s medical school and the study’s corresponding author.
“The results are disappointing, but not surprising.
“If you have high blood pressure, controlling it is a lifelong commitment,” Pajewski said.
The first published research findings, disclosed in 2015, determined that intensive blood pressure management can reduce cardiovascular disease and lower the risk of death.
A separate study under the SPRINT MIND umbrella released in 2019 determined that intensive management of blood pressure may play an important role in reducing the odds of developing mild cognitive impairment. That report was published by the Journal of the American Medical Association.
The study has confirmed that in adults 50 years and older with high blood pressure, targeting a systolic blood pressure of less than 120 millimeters of mercury (mm Hg) reduced rates of cardiovascular events, such as heart attack and heart failure, as well as stroke, by 25%.
The target also reduced the risk of death by 27% — as compared to a target systolic pressure of 140 mm Hg.
In the latest study, Pajewski and team linked participants to the National Death Index from 2016 to 2020, which added 4½ years of follow-up for mortality after the conclusion of the trial.
They also examined the electronic health records of trial participants for outpatient measurements of blood pressure.
“In addition to a diminishing benefit of intensive treatment on cardiovascular mortality, we saw a gradual increase in blood pressure for participants in the intensive treatment group, such that, four or five years after the trial, there no longer appeared to be a difference in systolic blood pressure between the groups,” Pajewski said.
“The message here is clear. Sustained blood pressure control is necessary to continue to reduce the burden of fatal cardiovascular events.”
SPRINT was co-sponsored by the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of Neurological Disorders and Stroke, and the National Institute on Aging.
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