New blood pressure target – the lower the better

Hundreds of millions of people worldwide could benefit from more intensive treatment to lower blood pressure, according to new research.

Professor Stephen MacMahon, Principal Director of The George Institute for Global Health and Professor of Medicine & James Martin Professorial Fellow, University of Oxford, said the research, which was published in The Lancet, showed that the lower the level of blood pressure achieved, the greater the reduction in heart attacks and strokes.

“We have previously shown that lowering blood pressure below 140 mm Hg is of great benefit to people with diabetes and people who have had a previous stroke, but this new finding indicates that the benefits are much wider,” Prof MacMahon said.

“By setting blood pressure targets too high, we have sharply limited the benefits that could have been achieved with blood pressure lowering drugs over the past few decades.”

“We urgently need new recommendations encouraging both doctors and patients to aim for much lower levels of blood pressure than were previously thought necessary.”

The study, Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis was conducted in partnership with Xinfang Xie, Jicheng Lv and others from Peking University First Hospital and found:

• Patients receiving more intensive treatment had their blood pressure lowered to 133 mm Hg, compared to 140 mm Hg among those receiving less intensive treatment
• This produced a 13% reduction in heart attacks and a 22% reduction in strokes
• Even patients who had a blood pressure less than 140 mm Hg to begin with, benefited from treatment

These findings are supported by a second study in the New England Journal of Medicine (NEJM), which also shows that setting lower blood pressure targets reduces the risk of stroke, heart attack and death.

Executive Director for the Institute, Professor Vlado Perkovic was asked to write the editorial for the research and said it was a game changer.

“There are very few treatments proven to reduce the risk of death among mostly healthy people, but lowering blood pressure to low target levels is now one of them,” Prof Perkovic said.

“The Systolic Blood Pressure Intervention (SPRINT) trial enrolled more than 9,000 people with blood pressure levels above 130 mm Hg who were at high risk of heart disease and stroke.

“It compared standard treatment goals of 140 mm Hg or less with more aggressive goals of 120 mm Hg or less.

“People treated to the lower target had their risks of major complications, including death, reduced by a quarter.”

Professor Perkovic said the research changes everything when it comes to understanding and treating high blood pressure.

“Now, with this research, more people can be treated appropriately with lifestyle modification, and if they are at high risk, blood pressure lowering medicines, achieving a big reduction in their risk of death,” he said.

“Globally, there are several billion people with blood pressure levels that are too high, which underscores the need for better prevention, like reducing salt intake.

“These latest results confirm that medical treatment for those at high risk of stroke or heart attack needs to be more intensive, and when this is achieved the benefits will be very worthwhile.

Professor of Global Health at the Institute, Anthony Rodgers said it had taken far too long to get to this point.

“The George Institute for Global Health has been recommending these changes for many years,” Prof Rodgers said.

“Many people have said the evidence has been ‘hiding in plain sight’ for a while now – but this will really be a tipping point.

“The big challenge now is implementing these effective treatments more widely among people at high risk.”

Xinfang Xie, Emily Atkins, Jicheng Lv, Alexander Bennett, Bruce Neal, Toshiharu Ninomiya, Mark Woodward, Fiona Turnbull, Graham S Hillis, John Chalmers, Jonathan Mant, Abdul Salam, Kazem Rahimi, Vlado Perkovic, Anthony Rodgers also contributed to the Lancet paper: Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis.