Should You Reduce Your Blood Pressure Even More?

Should you lower your blood pressure target?

Lower pressure saves lives
Lower your target?. Getty

High blood pressure is a leading risk factor for heart disease, stroke, kidney failure, and cognitive decline Current estimates suggest as many as one in three adults in the United States have hypertension. Over sixty percent of people over the age of 65 have hypertension and those numbers are increasing. Systolic blood pressure, the top number in a blood pressure recording, has generally been targeted at 140 mm Hg, although doctors have long acknowledged that lower systolic blood pressures are a desirable goal.

 Although observational studies have demonstrated a progressive risk of complications with blood pressures higher than 115/75 mm Hg, the optimal systolic blood pressure target to reduce risk has not been clearly identified. Your doctor will carefully consider your risk factors for conditions like cardiovascular disease or kidney disease when setting a target goal for your blood pressure. 

The first experimental study to attempt to determine the risks and benefits of intensive blood pressure treatment is the SPRINT study, Systolic Blood Pressure Intervention Trial. This is a  large study funded by the National Institutes of Health that enrolled over 9,000 volunteers in 100 centers nationwide. Subjects included adults over the age of 50 who had hypertension and risk factors for outcomes like stroke, cardiovascular disease, or chronic kidney disease. The subjects were divided  randomly into two groups.

One group was treated to achieve standard blood pressure target of less than 140 mm Hg and the other group was treated to target more intensive blood pressure control, with a systolic blood pressure target of less than 120 mm Hg. 

The SPRINT study was  stopped in mid-September, almost a year before completion, as researchers determined the study had already provided potentially life-saving information.

The results appear clear: lower blood pressure guidelines save lives. 

 Lowering blood pressure below the commonly used target systolic blood pressure measurement of 140 mm Hg significantly reduced serious heart disease and the risk of death in adults aged 50 and over.

SPRINT was an effort to determine the optimum level for blood pressure reduction.The results indicate our current guidelines leave room for improvement. Lowering systolic blood pressure to 120 mm Hg cut the rate of strokes, heart attacks, and congestive heart failure by nearly one-third. Maintaining a lower blood pressure also reduced the risk of death by almost 25% in patients who maintained a target of 120 mm Hg systolic, compared to those who targeted 140 mm Hg as the goal for systolic blood pressure.  

The guidelines for blood pressure management haven't formally changed, so what should you do? Study researchers caution that it is not yet clear if current practice should change as a result of the study. Data must be analyzed to determine which groups of individuals may benefit from more intensive blood pressure control.

 Different populations may achieve different benefits from lower blood pressure numbers. Some people, particularly the elderly or people with atherosclerotic disease, may benefit from maintaining a higher blood pressure. Older people can become dizzy and may experience fainting or falls if their blood pressure becomes too low. Other people may receive significant health benefits by instituting more intensive control right away. Your doctor can discuss whether or not you should set a more intensive target for lowering your blood pressure. 

Final results from the SPRINT trial will probably be published within the next few months.  The study results will be considered with other clinical evidence by organizations that develop clinical practice guidelines. Until clinical guidelines are published, your doctor may or may not choose to change your treatment. However, in addition to changing medications, you can lower your blood pressure by making healthy lifestyle changes, like exercising, eating a healthy diet, maintaining a healthy weight, and managing stress in your life.

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