By the Numbers

How low should you go on lowering blood pressure?

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When it comes to blood pressure, it looks like less may well be more for those who are 50 and older.

That’s according to results of a new study that shows the risk of death can be cut by a quarter, and the risk of heart attack or stroke can be reduced by a third, through aggressive use of medication to lower blood pressure readings well below current standards.

The National Institutes of Health (NIH) reported its findings on Sept. 11. The results of the study, the Systolic Blood Pressure Intervention Trial (SPRINT) were so compelling that researchers ended their work early to share their conclusions.

Here, succinctly stated, is why you should care:

“High blood pressure is an important public health concern, due to the fact it can be prevented and is a significant risk factor for death, coronary disease, stroke, heart failure and renal failure.” So says Dr. Rajiv Malhotra, and he should know: He’s an assistant professor of internal medicine, medical director of the cardiac surgery ICU and fellowship director of interventional pulmonary medicine for the VCU Medical Center.

About one third of Americans have high blood pressure (also called hypertension) and about half have it under control, according to the Centers for Disease Control and Prevention.

Where should your numbers be?

The optimal reading for most folks is at or below 120/80. Established guidelines call for treatment for those age 60 and younger who have readings greater than 140/90, and for age 80 and older with readings above 150/90. For those between ages 60 and 80, treatment depends on whether they have risk factors such as diabetes or kidney disease, Malhotra notes.

The first, or top, number in a blood pressure reading measures systolic pressure, the pressure in your arteries when the heart muscle contracts. The second, or bottom number is a measurement of diastolic pressure, the pressure in the arteries when the heart muscle is between beats and is filling with blood.

The NIH study began in 2009, and included a diverse group of 9,300 people age 50 and older. Participants were either age 75 and older without additional risk factors, or 50 to 75 with additional risk factors such as chronic kidney or cardiovascular disease, Malhotra says.

Participants in both age ranges were divided into two groups: One received treatments to achieve a systolic reading less than 140 (the current standard), and an “intensive treatment group” that received medications designed to lower the systolic pressure to less than 120. The first group averaged two medications each, and the second group, on average, was placed on three medications.

Malhotra describes the SPRINT trial’s individualized approach as similar to the way cholesterol level goals are currently set for individuals.

“It makes sense that not everyone can have the same goal,” he says by email.

Of course, you can’t generalize from one study, because the results only reflect what happened in the study population: 50 and older with risk factors, or 75 and older without risk factors.

There are other factors to consider in implementing aggressive treatment with medications, as well. One is cost, which will rise in prescribing additional medications. Another concern, especially with older patients, is blood pressure becoming too low, which can lead to dizziness and falling, renal failure and other problems, Malhotra says.

It’s “important for patients to remember that medication works best in the context of improved dietary intake and an attempt at weight loss with exercise,” he adds. “That can help limit the number of medications needed, or even the need for medications, and thus cost.”

To complicate matters, the Journal of the American Medical Association in August 2014 called for a blood pressure reading below 140/90 for ages 30 to 59, and below 150/90 for ages 60 and older.

What should be your takeaway from all this? Here’s Malhotra’s advice:

“Your goal blood pressure should be determined by you and your doctor based on your [health] and risk factors. We know that hypertension or high blood pressure is certainly bad for you. Blood pressure control is very important, and hypertension is frequently called the silent killer because no other symptoms occur with hypertension and the detrimental effects occur over years and decades. A person can be walking around with a blood pressure of 180 for decades without symptoms. The real harm is happening silently with excess work placed on the heart and damage to the vessels in the brain and kidneys. Eventually this all catches up with the patient and they have a heart attack, stroke renal failure or death.”

GIANT STRIDES IN BABY STEPS

A VCU researcher and a University of Oklahoma collaborator are part of a baker’s dozen presenters participating on Saturday and Sunday in the Innovation Festival, a celebration of cutting-edge technology, to be held at the Smithsonian Institution in Washington.

They’ll be showing off a device they’ve developed that helps infants with neuromuscular disorders to crawl about and explore, and may one day be adapted to help blind children, too.

The device is akin to a motorized skateboard and is called the Self Initiated Prone Progressive Crawler.

It’s the creation of Dr. Peter Pidcoe, associate professor and assistant chairman of the Department of Physical Therapy in the VCU School of Allied Health Professions, and Dr. Thubi Kolobe, a professor in the University of Oklahoma’s Department of Rehabilitation Sciences.

The device helps children with diseases such as cerebral palsy to move about and explore their environment, a skill crucial to cognitive development.

Check back Oct. 1 for more on the device and an interview with Pidcoe.

The event will be held at the Smithsonian National Museum of American History in its new Innovation Wing. The festival also is sponsored by the U.S. Patent and Trademark Office. Hours are 10 a.m. to 5 p.m. each day.

TAKE-BACK DAY

All those unused and outdated medications you have around the home need to go.

You can safely dispose of prescription drugs and over-the-counter medications from 10 a.m. to 2 p.m. Saturday at sites across the city as part of the National Prescription Drug Take-Back Day. It’s a U.S. Drug Enforcement Administration-sponsored, national event.

Here’s a partial list of Richmond-area take-back sites. You can find more here.

  • Amelia Pharmacy,15412 Patrick Henry Highway, Amelia
  • Colonial Orthopedics, 325 Charles Dimmock Parkway, Colonial Heights
  • Meadowbrook High School front parking lot, 4901 Cogbill Road, North Chesterfield
  • Rite Aid Pharmacy, 15101 Patrick Henry Highway, Amelia
  • Walmart, 3500 S. Crater Road, Petersburg
  • West Creek Emergency Center, 12720 Tuckahoe Creek Court, Richmond    

PRETTY IN PINK

You can enjoy an evening of food, wine and fun and support breast cancer patients at Pink for a Purpose.

The event, a fundraiser for the Bon Secours Richmond Health Care Foundation Cancer Care Fund, will be held from 5 to 9 p.m. on Thursday, Oct. 8, at the Short Pump Town Center main plaza, 11800 W. Broad St.

Wine and food tastings will feature fare from several of the development’s restaurants. Other businesses will offer discounts on merchandise, according to a news release from Bon Secours.

You also can talk with breast health experts and schedule a mammogram. An illumination ceremony will be held in honor of breast cancer survivors and fighters.

Admission is $25, with all proceeds going to the cancer care fund. You’ll find a list of participating restaurants and merchants and can purchase tickets here.