A new study led by researchers at Mass General Brigham suggests that aiming for lower blood pressure could prevent more heart problems, even though it might also lead to more side effects.
The research, published in the journal Annals of Internal Medicine, used simulation models to compare the long-term health effects of three different blood pressure goals: under 120, 130, and 140 mm Hg.
Doctors often worry about treating high blood pressure too aggressively because blood pressure medications can cause side effects, such as dizziness, kidney problems, or a slow heart rate.
However, this study found that aiming for a lower blood pressure goal—especially under 120 mm Hg—could lead to fewer heart attacks, strokes, and cases of heart failure.
To reach these findings, the team used health data from previous major studies like the SPRINT trial, as well as national health surveys and other published research.
They created a computer model that simulated how people would do over their lifetimes under different blood pressure targets. The model also included common real-life mistakes in blood pressure readings, which can happen during routine doctor visits.
Even after accounting for these errors, the results showed that the stricter target of under 120 mm Hg helped prevent more cardiovascular events than the more relaxed targets of under 130 or 140 mm Hg.
That said, there were some downsides. The more aggressive blood pressure goal was linked to more treatment-related issues, including falls, kidney injury, low blood pressure, and slow heart rate. It also increased healthcare costs because patients needed more medications and more frequent doctor visits.
Despite these challenges, the researchers found that the lower blood pressure goal was still a good value when it came to cost-effectiveness. They calculated that it cost about $42,000 per quality-adjusted life year gained, which is considered reasonable in healthcare economics.
“This study should give patients at high risk for heart disease more confidence in setting lower blood pressure goals,” said Dr. Karen Smith, lead author of the study and a researcher at Brigham and Women’s Hospital.
“Our results show that going for the <120 mm Hg target can save lives and is worth the cost, even if blood pressure measurements aren’t always perfect.”
However, Smith also warned that aggressive treatment might not be right for everyone. Since stronger medications come with more side effects, it’s important for patients and doctors to talk about what works best for each individual. Not everyone will benefit from intensive treatment, and personal preferences and risk factors should guide the decision.
In short, while aiming for a lower blood pressure can lead to better heart health, it should be done carefully and with the patient’s unique situation in mind.
The study is published in Annals of Internal Medicine.
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