A Lower Low for Patients with High Blood Pressure

Fountainhead: a Lower Low for Patients with High Blood Pressure

A healthy blood pressure has long been associated with decreased risk of certain diseases. Now, researchers theorize that lowering systolic blood pressure below the currently recommended level could lead to a greater reduction of risk, and Case Western Reserve University School of Medicine will be part of a multi-center clinical trial to test that theory.

The School of Medicine has received a $14.7 million, nine-year contract from the National Institutes of Health (NIH) to be one of five institutions to lead a trial to determine if lowering systolic blood pressure in hypertensive patients without diabetes to below currently recommended levels can reduce the incidence of cardiovascular and kidney disease and slow cognitive decline.

Case Western Reserve will head a Clinical Center Network consisting of investigators from its School of Medicine and six other Northeast Ohio clinical centers: Cleveland Clinic, Louis Stokes Cleveland VA Medical Center, MetroHealth Medical Center, Northeast Ohio Health Centers, St. Vincent’s Charity Hospital and University Hospitals, as well as the Ohio State University College of Medicine. It will be directed by Jackson T. Wright Jr., MD, PhD, professor of medicine at Case Western Reserve and director of the Clinical Hypertension Program at University Hospitals Case Medical Center.

Wright says the study will evaluate whether treating patients to a systolic blood pressure of less than 120 mmHg reduces the risk of cardiovascular and kidney disease, or age-related cognitive decline, more than the usually recommended level of 140 mmHg. “We suspect that treating to the lower level of 120 mmHg will result in fewer cardiovascular and kidney complications. However, this needs to be proven,” he adds.

The results of this study will grow the small body of evidence surrounding this hypothesis. Called SPRINT (Systolic Blood Pressure Intervention Trial), the study findings will be used to reevaluate the optimal blood pressure for patients and have the potential to establish new guidelines for health care providers. SPRINT will enroll more than 9,000 participants, age 55 or older, with systolic blood pressure of at least 130 mmHg. All participants will have a history of cardiovascular disease or be at high risk for heart disease by having at least one additional risk factor (except diabetes); between 40 and 50 percent will have chronic kidney disease. Blacks and other minorities will comprise at least 40 percent of the study. Once enrollment begins in October, the Case Western Reserve network will recruit between 1,500 and 1,800 patients over the next two years.