High blood pressure, also known as hypertension, is one of the most common health problems in the world. It affects millions of people and is a major risk factor for heart attacks, strokes, heart failure, and kidney disease.
For many years, doctors have debated how low blood pressure should be lowered with medication. While lowering blood pressure can protect the heart and blood vessels, some experts worry that pushing it too low might cause harm, especially in older adults.
A new study led by researchers at Mass General Brigham offers important insight into this debate. The researchers found that aiming for more aggressive blood pressure control may provide greater long-term health benefits than previously thought.
Their findings suggest that the benefits of lowering blood pressure to very low levels outweigh the risks for many people at high risk of heart disease. The study was published in the medical journal Annals of Internal Medicine.
To better understand the long-term effects of different blood pressure targets, the researchers used a detailed computer simulation. Instead of following real patients for decades, which would be difficult and costly, they combined data from several large and well-known studies.
These included the Systolic Blood Pressure Intervention Trial, often called SPRINT, as well as national health data from the National Health and Nutrition Examination Survey. They also used information from earlier scientific research to strengthen their model.
The researchers focused on systolic blood pressure, which is the top number in a blood pressure reading. This number shows how much pressure is in the arteries when the heart beats.
They compared three different treatment goals: keeping systolic blood pressure below 140 millimeters of mercury, below 130, and below 120. These targets reflect common treatment strategies used by doctors today.
The simulation estimated what would happen to patients over their lifetime under each blood pressure goal. It looked at major health outcomes such as heart attacks, strokes, heart failure, and death. At the same time, the researchers considered the risks linked to blood pressure medications.
These risks included falls, kidney problems, very low blood pressure, and slow heart rate. The model also included common mistakes that happen when blood pressure is measured in everyday medical settings, such as readings being slightly too high or too low.
Even after accounting for these measurement errors, the results were clear. People whose blood pressure was lowered to below 120 experienced fewer heart attacks, strokes, and cases of heart failure compared to those with higher targets. This means that more intensive blood pressure treatment could prevent a large number of serious cardiovascular events.
However, the study also confirmed that stricter blood pressure control comes with trade-offs. People in the lowest target group had a higher chance of side effects related to medication.
They were more likely to experience falls, kidney injury, dizziness from low blood pressure, and slow heart rate. More frequent doctor visits and higher medication use also led to increased healthcare costs.
Despite these drawbacks, the researchers found that the most aggressive blood pressure target still provided good value overall. When they measured cost-effectiveness, the below-120 target was considered cost-effective by standard healthcare guidelines.
The estimated cost was about forty-two thousand dollars per quality-adjusted life year gained, a common measure used to judge whether medical treatments are worth the cost.
The lead author of the study explained that these findings should reassure both patients and doctors who are considering more intensive blood pressure treatment.
The results suggest that lowering blood pressure more aggressively can prevent serious heart problems and provide strong health benefits, even when real-world challenges like imperfect measurements are taken into account.
At the same time, the researchers emphasized that intensive treatment is not right for everyone. Some patients may be more sensitive to medication side effects or may have other health conditions that make aggressive treatment risky. Personal preferences, lifestyle, age, and overall health should always be part of the decision-making process.
In reviewing these findings, the study supports the idea that lower blood pressure targets can significantly reduce the risk of major heart-related events for many people. It also shows that concerns about overtreatment, while valid, may be outweighed by the long-term benefits at a population level.
The research highlights the importance of personalized care, where patients and doctors work together to balance benefits, risks, and quality of life.
Overall, this study adds strong evidence that carefully managed intensive blood pressure control can save lives, reduce serious disease, and offer good value to the healthcare system. It encourages a thoughtful but confident approach to lowering blood pressure in people who face a high risk of heart disease.
If you care about high blood pressure, please read studies about unhealthy habits that may increase high blood pressure risk, and drinking green tea could help lower blood pressure.
For more information about high blood pressure, please see recent studies about what to eat or to avoid for high blood pressure, and 12 foods that lower blood pressure.
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