High blood pressure / hypertension

Personalized Treatment for Those in Blood Pressure “Gray Zone”

Using data from a national study, Johns Hopkins researchers determined in 2017 that heart CT scans can help personalize treatment for patients whose blood pressure falls in the “gray zone” of just above normal or mild high blood pressure. A release from Johns Hopkins explains that previously the appropriate blood pressure treatment for these patients used risk calculations and some guesswork, potentially leaving many vulnerable to heart disease or taking drugs they don’t need. Nearly one in three adults in the U.S. has prehypertension, which is defined as blood pressure higher than normal but not considered high yet.

The scans detect levels of calcium in the heart’s arteries, and the physicians suggest those people with the highest calcium levels would benefit most from aggressive blood pressure treatment, whereas those with little or no calcium may not need to be treated as intensively, depending on their other heart disease risk factors.

In the study, published on January 10th 2017 in Circulation, the researchers say these calcium scores allow physicians to go beyond the traditionally calculated risk factors to determine which blood pressure treatment strategy may be most appropriate for a particular patient.

The release quotes J. William McEvoy, M.B.B.Ch., M.H.S, assistant professor of medicine and member of the Ciccarone Center for the Prevention of Heart Disease at the Johns Hopkins University School of Medicine, as saying, “If a health care provider wants to target blood pressure in a patient with traditional heart disease risk factors and above-normal blood pressure, he or she can look at coronary artery calcium to help with tie breaker like decisions. Our study, along with others, such as SPRINT and HOPE, positions cardiac risk and coronary artery calcium as helpful ways to determine if a given patient would either benefit from more intensive blood pressure control or do just fine with a more traditional blood pressure target.”

In late 2015, the SPRINT trial showed improved outcomes for participants with increased risk for heart disease whose physicians targeted their systolic (the top number) blood pressures to 120 millimeters of mercury, rather than the traditional 140 millimeters of mercury. But not all people deemed “higher risk” by traditional methods may need to be aggressively treated, McEvoy says. Some people react poorly to higher doses of blood pressure medicines and experience side effects, such as sexual dysfunction, dizziness, falls, weakness, and more. And the risk factor equations that determine whether certain people are at higher risk and should be treated more intensively with blood pressure medications may have inaccuracies on the individual level, says McEvoy. “We can predict that about 15 out of every 100 people with a particular risk score will die of a heart attack, but the equations don’t tell us which of those people will be one of the actual 15; they don’t give us personalized information,” says McEvoy.