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Targeting a systolic blood pressure below 120 mm Hg in hypertensive patients effectively reduces major vascular events with minimal increased risk.
In a pioneering study, reducing systolic blood pressure (SBP) to below 120 mm Hg was found to decrease the likelihood of major cardiovascular events in high-risk hypertensive patients, outperforming the usual target of below 140 mm Hg. The large-scale study, conducted across 116 hospitals in China, followed over 11255 participants, including those with diabetes and prior strokes, to see which treatment strategy offers the best protection.
In this randomized controlled trial, patients (average age 64.6 years) with high cardiovascular risk were allocated to either an intensive treatment group (n=5624; achieving SBP below 120 mm Hg) or a standard treatment group (n=5631; achieving SBP below 140 mm Hg). The key endpoint measured was a composite of major cardiovascular events, including heart attack, revascularization, heart failure hospitalization, stroke, or cardiovascular death, using the intention-to-treat principle.
During the follow-up period, the mean SBP was 119.1 mm Hg in the intensive treatment group. Contrarily, in the standard treatment group, it was 134.8 mm Hg. Over a median follow-up of 3.4 years, the key endpoint occurred in 9.7% (547 patients) of the intensive group and 11.1% (623 patients) of the standard group, with a hazard ratio of 0.88. There was no variation in effects based on diabetes status or history of stroke.
Severe adverse events, such as syncope, were more commonly reported in the intensive group (0.4%) when compared to the standard group (0.1%). Regarding hypotension, electrolyte imbalances, injurious falls, or acute kidney injury, no vital differences were noted between the groups. Thus, a SBP goal of 120 mm Hg is more beneficial than 140 mm Hg for preventing major vascular events, with a minimal added risk.
The Lancet
Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial
Jiamin Liu et al.
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