A new study from researchers at Mass General Brigham suggests that lowering blood pressure more aggressively could save more lives and reduce heart-related problems, even though it might come with extra side effects and costs. The results were published in the medical journal Annals of Internal Medicine.
High blood pressure, also called hypertension, is a major risk factor for heart attacks, strokes, and heart failure. Doctors often set a goal for how low a patient’s blood pressure should be, and this study looked at whether aiming for lower targets might be worth it.
To find out, the researchers used data from several sources, including the Systolic Blood Pressure Intervention Trial (SPRINT), the National Health and Nutrition Examination Survey (NHANES), and other studies.
They used this information to build a computer simulation that predicted long-term health outcomes for people with different blood pressure goals. The three targets they studied were systolic blood pressure (the top number) of less than 120 mm Hg, less than 130 mm Hg, and less than 140 mm Hg.
The team wanted to know how these different targets would affect the chances of heart attack, stroke, heart failure, and even death.
They also looked at possible harms from taking stronger blood pressure medicines, such as dizziness, kidney problems, slow heart rate, and falls. They included the cost of treatment and doctor visits to see whether the benefits were worth the extra money.
The simulation also factored in common errors in how blood pressure is measured during regular doctor visits, which can sometimes give results that are too high or too low.
Even after accounting for those errors, the results showed that aiming for a systolic blood pressure below 120 mm Hg prevented more heart problems than aiming for 130 mm Hg.
People in the lower blood pressure group had fewer heart attacks, strokes, and cases of heart failure. However, this group also had more side effects from the stronger medications and had to spend more time and money on healthcare.
To see if the lower target was worth the added cost, the researchers used a measure called “cost per quality-adjusted life year.” This measure combines how long people live with the quality of their life. They found that the cost of the more aggressive treatment was about $42,000 for each extra year of good health gained, which is considered a good value in public health.
Dr. Karen Smith, the study’s lead author, said the findings should help doctors and patients feel more confident about aiming for a lower blood pressure, especially for people at high risk of heart disease. She noted that even if blood pressure readings are not always perfectly accurate, the lower goal still offers clear health benefits.
But she also warned that aggressive treatment is not right for everyone. Since the stronger medicines can lead to side effects, doctors and patients need to work together to decide what is best for each individual, based on their health and personal preferences.
This study was a team effort. Alongside Dr. Smith from Brigham and Women’s Hospital, other researchers from Mass General Brigham, Cornell University, and Harvard University contributed to the work.
Overall, the study offers strong support for aiming lower with blood pressure targets, especially for patients at high risk of heart problems. While the approach may involve more medication and more careful monitoring, it could help many people live longer, healthier lives.
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