A new study from researchers at Mass General Brigham shows that aggressively lowering high blood pressure may offer major health benefits, even when there’s a risk of some side effects.
The study suggests that aiming for a lower blood pressure target—specifically below 120 mm Hg—could help prevent heart attacks, strokes, and heart failure better than higher targets like 130 or 140 mm Hg.
The findings were based on a detailed computer simulation that looked at how people’s health would change over their lifetime depending on how low their blood pressure was kept.
The researchers used data from several trusted sources, including the Systolic Blood Pressure Intervention Trial (SPRINT), the National Health and Nutrition Examination Survey (NHANES), and other medical studies. They compared the effects of three systolic blood pressure targets: below 120, below 130, and below 140 mm Hg.
Systolic blood pressure is the top number in a blood pressure reading and shows how much pressure your blood is pushing against your arteries when your heart beats. For most people, a reading of 120/80 is considered healthy. But for those at risk of heart disease, experts have debated whether to aim for even lower targets.
The simulation also included real-life issues like common errors in blood pressure readings taken in doctor’s offices. Even after accounting for these errors, the researchers found that the lowest target—below 120 mm Hg—still prevented more serious health problems than the other targets.
However, this lower target also came with increased side effects, such as dizziness, kidney problems, or a drop in heart rate. Patients on more medication also needed more frequent doctor visits.
The researchers examined the cost of each approach by measuring cost per quality-adjusted life-year, or QALY. This is a way of evaluating both the quantity and quality of life.
They found that the lowest blood pressure goal, below 120 mm Hg, was cost-effective. The estimated cost was $42,000 per QALY gained, which falls within the range that experts consider a good use of healthcare money.
Dr. Karen Smith, the study’s lead author and a researcher at Brigham and Women’s Hospital, said the results support using an intensive blood pressure target for people who are at high risk for heart disease.
She noted, “Our findings suggest the intensive <120 mm Hg target prevents more cardiovascular events and provides good value, even when measurements aren’t perfect.”
Still, Dr. Smith cautioned that aggressive blood pressure control might not be right for everyone. While the study looked at large groups of people, individual patients might react differently to medication. Some people may be more likely to experience side effects and may prefer a more cautious approach.
She emphasized that patients and doctors should make decisions together, taking into account each person’s health history and preferences. “Intensive treatment may not be ideal for every patient,” she said. “It’s important to talk with your doctor about what works best for you.”
This research offers strong evidence that lower blood pressure goals can lead to longer, healthier lives for many people—especially those at risk for heart disease. But it also shows that personalized care is key to getting the best results.
If you care about blood pressure, please read studies that timing matters when taking high blood pressure pills and 1 in 5 people with high blood pressure taking a drug worsen the disease.
For more about blood pressure, please read studies that new research challenges conventional blood pressure guidelines and scientists make a big breakthrough in high blood pressure treatment.
The study is published in Annals of Internal Medicine.
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