High blood pressure is often called a silent killer because it usually causes no obvious symptoms while quietly damaging the body over many years.
It is one of the leading causes of heart attacks, strokes, heart failure, and early death around the world.
For decades, doctors have worked to determine the safest and most effective blood pressure targets for people at risk of heart disease. Now, a large new study suggests that lowering blood pressure more aggressively may provide even greater protection than previously thought.
The research was presented at the American Heart Association Scientific Sessions in 2023 and was led by Dr. Jing Li from the National Center for Cardiovascular Diseases in Beijing, China.
The study, known as the ESPRIT trial, examined whether reducing systolic blood pressure to below 120 mm Hg could improve health outcomes compared with the more commonly used target of below 140 mm Hg.
Blood pressure is measured using two numbers. The top number, called systolic blood pressure, shows the pressure inside the arteries when the heart pumps blood. The bottom number, known as diastolic blood pressure, measures the pressure when the heart rests between beats.
Doctors have long known that keeping blood pressure under control reduces the risk of serious health problems, but there has been ongoing debate about how low blood pressure should go.
To investigate this question, researchers followed more than 11,000 adults in China who had high blood pressure and were considered at high risk for cardiovascular disease.
The participants included many older adults, and a significant number had already experienced conditions such as heart attacks or strokes. The average age of participants was 64 years, making the findings particularly relevant for older people who face a greater risk of heart-related complications.
The researchers randomly divided participants into two groups. One group received intensive treatment designed to lower systolic blood pressure below 120 mm Hg.
The other group received standard treatment aimed at keeping systolic pressure below 140 mm Hg. Both groups used blood pressure medications, but those in the intensive treatment group often needed more medicines or higher doses to reach their lower target.
After three years of follow-up, the results showed clear benefits for people whose blood pressure was lowered more aggressively. Participants in the intensive treatment group were 12% less likely to experience major cardiovascular events, including heart attacks and strokes.
They were also 39% less likely to die from cardiovascular disease. Perhaps most importantly, they were 21% less likely to die from any cause during the study period.
These findings suggest that maintaining a lower blood pressure target may provide substantial protection for people who are already at high risk of heart disease. For many patients, preventing even one heart attack or stroke can make a major difference in quality of life and long-term health.
Some healthcare professionals have worried that lowering blood pressure too much could increase the risk of side effects such as dizziness, fainting, or falls. In the ESPRIT trial, fainting occurred slightly more often in the intensive treatment group.
However, the increase was small, affecting only about three additional people per 1,000 patients. Researchers concluded that the benefits of reducing heart attacks, strokes, and deaths greatly outweighed this small risk.
The findings are also important because they support results from previous studies conducted in other countries.
One of the most influential was the SPRINT trial in the United States, which also found that lowering systolic blood pressure below 120 mm Hg significantly reduced the risk of cardiovascular events and death among high-risk individuals. The new Chinese study strengthens the evidence by showing similar benefits in a large and diverse population.
High blood pressure remains one of the most common health conditions worldwide. It is often linked to factors such as aging, obesity, lack of exercise, unhealthy diets, smoking, excessive alcohol consumption, diabetes, and family history.
Fortunately, blood pressure can often be improved through a combination of healthy lifestyle habits and medications when needed.
Simple steps such as reducing salt intake, eating more fruits and vegetables, staying physically active, maintaining a healthy weight, avoiding smoking, and following medical advice can all help improve blood pressure control.
Regular blood pressure checks are also important because many people do not realize they have high blood pressure until serious complications develop.
Although more research is needed to understand the long-term effects of intensive blood pressure treatment, the ESPRIT trial provides encouraging evidence that aiming for a lower systolic blood pressure target may help many high-risk individuals live longer and healthier lives.
The study adds to growing evidence that careful blood pressure management remains one of the most effective ways to protect the heart, brain, and blood vessels from serious disease.
The findings were presented at the American Heart Association Scientific Sessions 2023 and contribute to ongoing research into the best strategies for preventing heart disease and stroke.
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