The report is now published in NEJM (New England Journal of Medicine) on 9,300 hypertensive patients over the age of 50. Their study subjects were randomly assigned to two groups, using drugs to lower blood pressure to a systolic of either below 120 or below 140. The study’s acronym is SPRINT (systolic blood pressure intervention trial), and results are summarized in TIME Nov 23, 2015, p. 19-20. Those numbers are already below the previously recommended pressure of 150, but even so the death rate was 43% lower for the 120s versus the 140s so the trial was discontinued for ethical reasons.
One would suppose that if the results were so spectacular that they stopped the experiment, they would immediately recommend that all patients over the age of 50 should have their blood pressure brought down to 120, unless there were other good reasons for not doing so. But no, the AHA and the American Medical Association will not change their current recommendations of 140/90 for most people and 150/90 for people over 60. The reasons are obscure because even at 150/90 1/3rd of Americans have hypertension, and if they lowered the definition to 120/70 it would include almost everyone. The doctors are consistently seeing patients with systolic higher than 150 so they are defining that average as normal. The problem is that it isn’t normal, it is sick, and hypertension and its derivatives are the most common cause of death in the United States.
Medical students were taught until recently to consider a normal systolic pressure to be 100 plus the patient’s age; thus an eighty year old, such as myself would expect to have 180/[?, say 110]. Instead I usually have close to 118/68 which would be good for an eighteen-year-old in good health. Doctors avoid giving medication to older people to lower their pressure to this level because of the problems of dizziness, confusion, and falling.
If a longitudinal study of 9,300 individuals with unequivocal results isn’t enough to change policy it’s going to be a long time before my intestinal microbiome treatment will be recommended.