MedicalResearch.com Interview with:
Dr. Jeff Williamson
Jeff D. Williamson, MD, MHS
Section on Gerontology and Geriatric Medicine
Interim Chair, Internal Medicine
Program Director, Sticht Center on Aging
Professor, Gerontology and Geriatric Medicine
Sticht Center on Aging, Department of Internal Medicine
Wake Forest School of Medicine
Winston-Salem, NC 27157
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Williamson: This is a deeper look into the SPRINT results published last November in the New England Journal of Medicine.
SPRINT was funded to add a larger number of adults over age 75 who live independently, including frail elders who can travel to their doctor’s office (not in a nursing home). These funds also added measures that would assess and categorize each person’s degree of frailty and also their walking speed which is a marker for frail health.
This support was provided via ARRA funds to the NIH.
SPRINT tested whether treating high blood pressure to a systolic blood pressure (SBP) target of <120 mmHg prevents more CVD (stroke, MI, CHF) morbidity and mortality than treating to a goal of >< 140mmHg. Epidemiological evidence for many years has indicated that the 120 mm Hg target would reduce CVD complications and death from Hypertension. However epidemiological data has also indicated that this lower target might be dangerous for the elderly, causing more falls in particular. 90% of medications used in SPRINT are generic.
These new results show that people over age 75 with high blood pressure (HBP) benefit just as much as younger people with high blood pressure, even if frail. The patients on intensive high blood pressure therapy did not fall more. Neither did they, overall, have more serious adverse events. Intensive systolic blood pressure therapy to a goal of ><120 mmHg prevented many of the high blood pressure related CVD complications that are associated with greater disability and nursing home placement.
These results do not apply for persons with Heart failure or type 2 diabetes.
MedicalResearch.com: What should readers take away from your report?
Dr. Williamson: People over age 75 who are still living at home can safely lower blood pressure and reduce their risk for stroke, heart attack and heart failure as well as death.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Williamson: More studies testing treatments for common conditions in elderly people need to include large numbers of older people and also measures of frailty.
SPRINT Is also continuing to follow these individuals to see if better blood pressure control could be a strategy for preventing Alzheimer’s disease.
Further follow up is also needed to understand any long term effects on the kidney as more people in the intensive group at all ages had episodes of transient declines in kidney function or mild decreases in kidney function over time.
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Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years
Jeff D. Williamson MD, MHS, Mark A. Supiano MD, William B. Applegate MD, MPH, Dan R. Berlowitz MD, Ruth C. Campbell MD, MSPH, Glenn M. Chertow MD, Larry J. Fine MD, William E. Haley MD, Amret T. Hawfield MD, Joachim H. Ix MD, MAS, Dalane W. Kitzman MD, John B. Kostis
MD, Marie A. Krousel-Wood MD, Lenore J. Launer PhD, Suzanne Oparil MD, Carlos J. Rodriguez MD, MPH, Christianne L. Roumie MD, MPH, Ronald I. Shorr MD, MS, Kaycee M. Sink MD, MAS, Virginia G. Wadley PhD, Paul K. Whelton MD, Jeffrey Whittle MD, Nancy F. Woolard , Jackson T. Wright MD, PhD, Nicholas M. Pajewski PhD
JAMA. doi:10.1001/jama.2016.7050 Published online May 19, 2016
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