Research conducted by a team at Mass General Brigham has revealed that the health benefits of aggressive blood pressure management significantly outweigh the risks of overtreatment for individuals with elevated blood pressure levels. The findings, recently published in the Annals of Internal Medicine, suggest that pursuing a more intensive blood pressure target can prevent serious cardiovascular events.
The study utilized data from the Systolic Blood Pressure Intervention Trial (SPRINT), the National Health and Nutrition Examination Survey (NHANES), and other scholarly sources to simulate lifetime health outcomes. These outcomes included heart attacks, strokes, and heart failure for patients with systolic blood pressure targets set at less than 120 mm Hg, 130 mm Hg, and 140 mm Hg. The research accounted for the side effects associated with blood pressure medications and compared the risk of severe treatment-related events.
Simulation Insights and Findings
The simulation model incorporated typical errors observed in routine clinical blood pressure readings. Despite these errors, the model indicated that a target of less than 120 mm Hg was more effective in preventing cardiovascular events compared to a target of less than 130 mm Hg. However, this more aggressive target also led to an increase in adverse events such as falls, kidney injury, hypotension, and bradycardia. Additionally, this target increased healthcare costs due to the higher use of antihypertensive medications and more frequent clinical consultations.
“The <120 mm Hg target was cost-effective, associated with a cost of $42,000 per quality-adjusted life-year gained."
Expert Opinions and Implications
Lead author Dr. Karen Smith, an investigator at the Department of Orthopedic Surgery at Brigham and Women’s Hospital, emphasized the potential benefits of intensive blood pressure management. “This study should give patients at high cardiovascular risk and their clinicians more confidence in pursuing an intensive blood pressure goal,” she stated. “Our findings suggest the intensive <120 mm Hg target prevents more cardiovascular events and provides good value, and this holds true even when measurements aren't perfect."
Dr. Smith also highlighted that while the study supports the cost-effectiveness of intensive treatment at the population level, it may not be suitable for every patient due to the increased risk of adverse events. “Patients and clinicians should work together to determine the appropriate medication intensity based on patient preferences,” she advised.
Context and Historical Comparisons
This research builds on previous findings from the SPRINT trial, which first demonstrated the benefits of lower blood pressure targets in reducing cardiovascular risk. Historically, the medical community has debated the optimal blood pressure targets, balancing the benefits of lower thresholds against the risks of medication side effects and patient quality of life. This study provides a nuanced perspective, suggesting that while intensive targets are beneficial, they require careful consideration of individual patient circumstances.
Future Directions and Considerations
As healthcare providers consider implementing more aggressive blood pressure management strategies, the study underscores the importance of personalized care. The findings advocate for a collaborative approach between patients and clinicians to tailor treatment plans that align with patient health goals and risk profiles.
Authorship for the study includes contributions from Thomas Gaziano, Alvin Mushlin, David Cutler, Nicolas Menzies, and Ankur Pandya, alongside Dr. Smith. The research received funding from the National Science Foundation and the National Institute of Neurological Disorders and Stroke, ensuring a robust and well-supported investigation into the cost-effectiveness of intensive blood pressure targets.
As the healthcare landscape continues to evolve, studies like this play a crucial role in informing clinical guidelines and patient care strategies, ultimately aiming to enhance health outcomes across diverse populations.
