DOCTORS ’ LOUNGE
DOCTORS ’ LOUNGE
80 ( a very high proportion of whom have hypertension ) were excluded ; participants with diabetes were also excluded ! Considering that diabetes disproportionately affects older women , and that stroke , as the third leading cause of death for women , kills twice as many women as breast cancer annually , I conclude that the designers of this study ( as happens so often in research ) failed to care enough about gender differences .
Additionally , the Sprint Study was stopped with not even four years of follow-up because it was found that those whose blood pressure was maintained below 120 did better . They had reductions of 25 percent for heart attack , other acute coronary syndromes , stroke , heart failure hospitalization or cardiovascular related death .
However , those whose blood pressure was kept below 120 also had increased rates of blood pressure that was too low , with fainting , falls , acute kidney injury and electrolyte abnormalities : all in only 3.7 years of follow-up .
In contrast , the Glasgow work above had more than 14 years of follow-up and focused on the degree of variability of blood pressure . A higher degree of variance over time - seen most in women , with increasing age , and with chronic kidney disease and concurrent heart disease - was associated in all time frames with worsened cardiovascular and non-cardiovascular mortality . The highest levels of blood pressure carried more than a 40 percent increased risk of major vascular events compared to the lowest quartile . But since the study primarily focused on variability in blood pressure , the authors gave no recommendation for a specific systolic target .
The ACCORD trial , also with a predominance of men , tried to show that intensive blood pressure lowering was better than regular blood pressure lowering ( that is less than 120 is better than less than 14 systolic ) and participants achieved an average difference of 14 mmHg in systolic blood pressure lowering . The protocol allowed either manual or digital BP measurement . Five years ’ follow-up failed to show any significant improvement from additional blood pressure lowering so far as time to cardiovascular death , to heart attack , or to stroke . However , it also showed a higher number of serious adverse events attributed to high blood pressure medications themselves , including “ events that were life-threatening , caused permanent disability or necessitated hospitalization .”
The ACCORDION trial followed up a subgroup of ACCORD participants for an additional 54 to 60 months ; however , that 14 mmHg systolic BP difference narrowed to only 2 to 3 mm Hg in the follow-up group , and again there was only a nonsignificant reduction in the risk of stroke .
Dr . Wenger , writing in the October American Journal of Medicine , noted that the Sprint Study had both significant under enrollment of women and low event rates in women ( in part due to the younger ages of women included ) and that the study should have been continued for much longer than it was , to try to capture accurate data as women aged . She noted that women are more likely to take medications that affect blood pressure control including antidepressants , thyroid hormone , immunosuppressant and nonsteroidal medicines . She noted that African-American women are at least three times more likely to develop ACE inhibitor related coughs , and that more than half of Hispanic women over 60 have either metabolic syndrome or actual diabetes , both of which greatly increase the risk for heart attack , major stroke , vascular dementia and heart failure .
My recommendation is that you take each person ’ s blood pressure yourself , and that the “ N of 1 ” study on blood pressure medication tolerability and effectiveness , for each person individually , is the best way to advise and design treatment . Marathon runners get high blood pressure too : just leading a healthy life cannot overcome the effects of the gene pool plus aging .
In the New Year , I have finally begun to carry around my very own manual blood pressure cuff , to save time , sanity and my own cerebral vessel plasticity , all of which have been endangered by the omnipresent plastic machines that purport to measure blood pressure digitally .
Dr . Barry practices Internal Medicine with Norton Community Medical Associates-Barret . She is a clinical associate professor at the University of Louisville School of Medicine , Department of Medicine .
JANUARY 2017 27