Once again, NIH release on blood pressure targets lacks info on absolute benefits, potential harms

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

The release makes no mention of costs associated with the differing strategies. It states that hypertensive elderly patients receive medication to lower their systolic blood pressure to either 140 mm of mercury or 120 mm of mercury, and that, on average, the patients who had a lower targeted blood pressure required an added medication. But no specific drugs are mentioned, so readers cannot judge whether there would be cost differences between this recommended regimen and their current therapy.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The release points out that those study participants whose blood pressure goal was 120 mm of mercury had 33 percent fewer cardiovascular events, such as heart attacks or heart failure, and had a 32 percent reduction in the risk of death, compared to those participants with a higher goal.  Based on this, it recommends that people 75 and older benefit from a lower systolic blood pressure.

But these numbers don’t tell the whole story. It should be noted that these relative reductions correspond with absolute risk reductions of only about 0.8 to 1.3 percentage points — reflecting a number needed to treat (NNT) of roughly 100. In other words, approximately 100 people need to be treated to this target in order for 1 person to experience an improved outcome. The other 99 don’t benefit but have the potential to experience adverse effects.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The release makes no mention of the possible adverse reactions to medications that lower blood pressure, although these are widely known.  Nor does the release mention any adverse reactions among the study participants other than those that were used as endpoints for the study — myocardial infarctions, strokes and heart failure, for example.

The published research article notes that while treatment carried risk of side effects for both patient groups studied, the differences between the serious side effects (low blood pressure, fainting, acute kidney injury) encountered in each group weren’t significantly significant.

Another issue not addressed in the release is that these patients were followed very closely by study staff and were examined initially every 3 months. In clinical practice, patients are often not seen that frequently which means that some patients might not get the level of monitoring needed to prevent or treat emerging complications.

We were pleased to see that the release cautioned patients to “talk to their doctor to determine whether this lower goal is best for their individual care.”

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

While this release does identify the main funding sources for the trial, it fails to mention any potential conflicts of interest, even though the paper itself discloses that three of the authors had numerous financial links to pharmaceutical firms.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

Again, the release explains a trial which presumably used different medications and/or different doses to reach the targeted systolic blood pressure levels (although none are identified). It offers no information on alternative mechanisms for reaching those goals and without more information on what approaches were used, it would be hard to cite alternatives.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Satisfactory

Without naming the drugs used in the study, the release leaves us to assume the ready availability of any of the medications. It would have been easy for the news release to indicate that the study did not use any investigational agents — just widely available blood pressure medicines. Unfortunately, the release doesn’t explain that, thus netting an unsatisfactory rating.