Study: Blood Pressure Below 120 Cuts Heart Events
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- Mass General Brigham researchers published a simulation study in Annals of Internal Medicine finding that targeting systolic blood pressure below 120 mm Hg prevented more heart attacks, strokes, and heart failure than the 130 mm Hg or 140 mm Hg targets.
- The team modeled lifetime health outcomes using data from the Systolic Blood Pressure Intervention Trial (SPRINT), the National Health and Nutrition Examination Survey (NHANES), and other published studies.
- Even after incorporating common inaccuracies in blood pressure readings seen in routine clinical settings, the <120 mm Hg target still outperformed the 130 mm Hg goal in preventing cardiovascular events.
- The more aggressive target carried higher risks of treatment-related side effects, including falls, kidney injury, hypotension, and bradycardia, plus increased healthcare costs from more medication and doctor visits.
- Despite added risks and expenses, the <120 mm Hg target remained cost-effective at approximately $42,000 per quality-adjusted life-year gained compared with higher targets.
- Lead author Karen Smith, PhD of Brigham and Women's Hospital said the findings apply at the population level and that intensive treatment "will not be optimal for all patients," urging shared decision-making.
- The research was funded by the National Science Foundation and the National Institute of Neurological Disorders and Stroke.
Why it matters: For clinicians weighing how aggressively to treat hypertension, the model offers population-level reassurance that pushing toward a <120 mm Hg target prevents more heart attacks, strokes, and heart failure at roughly $42,000 per quality-adjusted life-year—a commonly accepted cost-effectiveness threshold—even when real-world blood pressure readings are imperfect. Individual patients, however, face higher odds of falls, kidney injury, and hypotension, so Smith emphasized the intensive goal will not be optimal for everyone.
