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Intensive Blood Pressure Treatment Goals: Evidence for Cardiovascular Protection From Observational Studies and

Paul K Whelton1,2, Joshua D Bundy1, Robert M Carey3

  • 1Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.

American Journal of Hypertension
|April 7, 2022
PubMed

Insights

Lowering systolic blood pressure (SBP) intensively reduces cardiovascular disease (CVD) events and mortality. Intensive SBP treatment benefits high-risk individuals, including older adults and those with diabetes or kidney disease.

Area of Science:

  • Cardiology
  • Public Health
  • Gerontology

Background:

  • Epidemiologic studies show a direct relationship between blood pressure (BP) and cardiovascular disease (CVD) events.
  • Clinical trials indicate that intensive antihypertensive drug treatment is more effective in preventing CVD than less intensive approaches.

Approach:

  • Meta-analyses of randomized controlled trials support intensive antihypertensive therapy, particularly for systolic blood pressure (SBP) targets of 130 mm Hg or even 120-124 mm Hg.
  • The Systolic Blood Pressure Intervention Trial (SPRINT) compared intensive SBP goals (<120 mm Hg) with standard goals (<140 mm Hg) in high-risk individuals.

Key Points:

  • Intensive SBP treatment (<120 mm Hg) significantly reduced CVD events and all-cause mortality in the SPRINT trial.
  • Benefits were observed across subgroups, including older adults (≥65 years) and those with diabetes or chronic kidney disease.
  • Intensive treatment also led to a lower incidence of cognitive impairment.

Conclusions:

  • Current guidelines often recommend an SBP target of <130 mm Hg for high-risk adults.
  • Intensive SBP management, potentially below 120 mm Hg, offers significant benefits for CVD prevention and mortality reduction in diverse high-risk populations.

Keywords:
antihypertensive treatmentblood pressureblood pressure targetsblood pressure treatmentguidelineshypertensionintensive antihypertensive treatment

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