Aggressively Lowering Blood Pressure Poses Danger to Older Patients

Elderly patients may experience more falls and blackouts with aggressive blood pressure management.

The authors of a new study suggest that physicians should be cautious when treating older patients with high blood pressure. These findings, published by JAMA Internal Medicine, are in contrast to a previous trial exploring aggressive approaches to lower blood pressure in this population.

Previously, the SPRINT study suggested that lowering systolic blood pressure to 120mmHg would result in less deaths compared with 140mmHg or less in adults 50 years and older with cardiovascular risks. The authors also found that common side effects of low blood pressure, including falls, injuries, and blackouts, were not observed, even in patients 75 years and older.

"SPRINT was a landmark study of hypertension treatment. While the benefits of lowering blood pressure seen in this study are not in dispute, we are highlighting to physicians that we need to be cognisant [sic] of the fact that the trial was not powered for adverse events such as falls causing injury,” said first author Donal Sexton in a press release. “Physicians ought not to expect a similarly low rate of adverse events in clinical practice as was observed in the trial when lowering blood pressure in older people. Overall what we are saying is that the risks and benefits of lowering blood pressure should be individualised [sic] for each patient."

In the new study, the authors focused on the potential adverse events associated with treatment requirements proposed by the SPRINT study in patients 75 years and older. These patients were followed up with for 3.5 years.

The authors discovered significantly different results. They found that aggressively lowering blood pressure was linked to 5 times more falls and blackouts than what was reported in SPRINT. Additionally, drops in blood pressure on standing were nearly double what was reported in SPRINT, according to the study.

These findings suggest that lowering blood pressure to 120mmHg may result in harm to elderly patients. The authors caution that a better understanding of which patients 75 years and older would benefit from this approach before adopting the guidelines of SPRINT, according to the study.

The authors are now exploring how to determine who may benefit from SPRINT treatment guidelines and who may be at risk, according to the study.

"Our work and that of other groups has shown that low blood pressure and particularly drops in standing blood pressure are linked not only to falls, fractures and fall- and blackout-related injuries, but also to depression and possibly other brain health disorders,” said principal investigator and lead author Rose Anne Kenny. "These outcomes can seriously impact on independence and quality of life and we advise caution in applying the SPRINT recommendations to everyone over 75 years without detailed assessment of an individual's risk versus possible benefit until such a time as we can provide more clarity re treatment."