A new study led by researchers at Mass General Brigham shows that aggressive blood pressure management can reduce the risk of heart attack, stroke, and heart failure. The benefits hold up even when common blood pressure measurement errors are taken into account.
The study was published in the Annals of Internal Medicine. Researchers used simulation modeling based on data from the Systolic Blood Pressure Intervention Trial (SPRINT), the National Health and Nutrition Examination Survey (NHANES), and other medical literature.
They analyzed the long-term health effects of targeting systolic blood pressure levels below 120 mm Hg, 130 mm Hg, and 140 mm Hg. The simulations predicted lifetime health outcomes for patients under each treatment goal.
The lowest target, under 120 mm Hg, prevented more cardiovascular events than the higher thresholds. These included fewer heart attacks, strokes, and cases of heart failure.
However, stricter control came with trade-offs. The intensive treatment increased the risk of side effects such as falls, kidney injury, low blood pressure (hypotension), and a slow heart rate (bradycardia).
It also raised healthcare costs. Patients required more medications and more frequent doctor visits.
Despite those drawbacks, researchers found the approach to be cost-effective. The intensive target was linked to about $42,000 per quality-adjusted life year gained, a measure used to weigh health benefits against costs.
“This study should give patients at high cardiovascular risk and their clinicians more confidence in pursuing an intensive blood pressure goal,” said lead author Dr. Karen Smith of Brigham and Women’s Hospital. “Our findings suggest the intensive <120 mm Hg target prevents more cardiovascular events and provides good value. This holds true even when measurements aren’t perfect.”
Smith added that the findings apply at a population level. She warned that aggressive treatment may not be right for everyone.
“Given the additional risk of adverse events related to antihypertensives, intensive treatment will not be optimal for all patients,” she said. “Patients and clinicians should work together to determine the appropriate medication intensity based on patient preferences.”
The study strengthens previous evidence in favor of tighter blood pressure control. But it also highlights the need for personalized care.