By Matthew E. Fink, MD
Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital
Dr. Fink reports he is a retained consultant for Procter & Gamble and Pfizer.
SOURCE: Berlowitz DR, Foy CG, Kazis LE, et al. Effects of intensive blood pressure treatment on patient reported outcomes. N Engl J Med 2017;377:733-744.
The Systolic Blood Pressure Intervention Trial (SPRINT; N Engl J Med 2015;373:2103) showed that among older adults with hypertension and a high risk of cardiovascular disease, blood pressure treatment that targeted a systolic blood pressure of < 120 mmHg (intensive treatment) led to lower rates of cardiovascular events and death than treatment that targeted a systolic blood pressure of < 140 mmHg (standard treatment). This recommendation was controversial, and there was great concern that adoption of the lower blood pressure target into general clinical practice might be limited by concerns regarding its effect on patient-reported outcomes, such as health status, quality of life, and satisfaction with care. In addition, reductions in cerebral blood flow, especially among older patients who have physical and cognitive impairments, might lead to lightheadedness, confusion, and falls with injury. Therefore, a study that looked at quality-of-life outcomes was organized to address these issues.
Berlowitz et al randomly assigned 9,361 participants with hypertension to a systolic blood pressure target of < 120 mmHg or a target of < 140 mmHg. Patient-reported outcomes included scores on the Physical Component Summary and Mental Component Summary of the Veterans RAND 12-item Health Survey, as well as a patient health questionnaire, which included items for depression, patient-reported satisfaction with care and blood pressure medications, and adherence to blood pressure medication prescriptions. Patients in the intensive treatment arm received an average of one additional antihypertensive medication and their median systolic blood pressure was 14.8 mmHg lower than the group that received standard care. There were no significant differences in the scores reported by patients regarding quality of life, depression, or patient-reported satisfaction scores. There were no significant differences regarding physical or cognitive function. Satisfaction with blood pressure care and medications was high in both treatment groups, and there were no significant differences in adherence to blood pressure medication prescriptions. In conclusion, the patient-reported outcomes in those who received intensive treatment with a target systolic blood pressure of < 120 mmHg were similar to those who received standard care, supporting the recommendations of SPRINT.