High blood pressure is one of the most common health problems in adults and a major cause of heart disease and stroke.
Because it often causes no obvious symptoms, many people can have dangerously high blood pressure for years without realizing it.
A new study from researchers at Mass General Brigham suggests that lowering systolic blood pressure to below 120 mm Hg could provide important benefits for some people at high risk of heart disease.
This more intensive approach may prevent more heart attacks, strokes, and cases of heart failure than aiming for higher targets.
The research was published in Annals of Internal Medicine. Instead of following one group of patients for their entire lives, the researchers created a detailed computer model to estimate the long-term effects of different blood pressure treatment strategies.
They used information from several major sources, including the Systolic Blood Pressure Intervention Trial, better known as SPRINT, and the National Health and Nutrition Examination Survey. They also included evidence from other medical studies.
The researchers compared three treatment goals for systolic blood pressure: below 120, below 130, and below 140 mm Hg. Systolic pressure is the top number in a blood pressure reading and measures pressure in the arteries when the heart contracts.
Blood pressure is written as two numbers, such as 120/80 mm Hg. The lower number is diastolic pressure, which measures pressure in the arteries while the heart rests between beats.
Doctors have long known that uncontrolled high blood pressure can damage blood vessels and organs. Over time, it can increase the risk of heart attacks, strokes, heart failure, kidney disease, and other serious health problems.
The harder question is how low doctors should try to bring blood pressure with treatment. Lowering it further may provide additional protection, but stronger treatment can require more medication and can also increase the chance of unwanted effects.
The new analysis found that targeting systolic pressure below 120 mm Hg prevented more major cardiovascular problems than targeting below 130 or 140 mm Hg. The advantage remained even when the researchers included common errors that can occur when blood pressure is measured in medical offices.
However, intensive treatment was not free of risks. People receiving more aggressive treatment may experience problems such as dizziness or kidney-related side effects and may require additional medicines and more frequent medical visits.
The researchers also examined whether the additional health benefits were worth the extra healthcare costs. They used a measure called a quality-adjusted life-year, or QALY, which combines additional years of life with the quality of those years.
The analysis estimated that targeting blood pressure below 120 mm Hg cost about $42,000 for each additional QALY gained. In commonly used health-economic assessments, the researchers considered this to represent reasonable value for the health benefits achieved.
The results therefore suggest that intensive blood pressure treatment could offer both medical and economic benefits for appropriate patients. Preventing a stroke or heart attack can protect quality of life while also avoiding expensive hospital care and long-term disability.
Still, a target below 120 mm Hg is not necessarily suitable for everyone. People differ in age, overall health, kidney function, medication use, risk of falls, and their ability to tolerate blood pressure drugs.
Some patients may experience troublesome side effects when their blood pressure is lowered aggressively. Others may need several medicines to reach the target, making treatment more complicated.
The researchers emphasized that decisions should therefore be made by patients and healthcare professionals together. A person’s cardiovascular risk, other medical conditions, possible side effects, and treatment preferences all need to be considered.
The study also relied on computer modeling, meaning it estimated lifetime outcomes using existing evidence rather than directly observing every participant for decades. Such models can provide valuable information, but their conclusions depend partly on the assumptions and data used to build them.
Overall, the findings add to evidence that tighter blood pressure control may prevent serious cardiovascular disease in many high-risk adults. The best target, however, remains an individual decision, and people should not change their blood pressure medicines or treatment goals without discussing the change with their healthcare provider.
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