Intensive blood-pressure control, aiming for levels below 120 mm Hg, has been found to prevent more heart-related events compared to standard targets, even when accounting for real-world measurement inconsistencies. This aggressive approach is not only more protective but also cost-effective, with an estimated cost of about $42,000 per quality-adjusted life-year gained. However, it is not without its drawbacks, including increased risks such as falls or kidney issues, and it necessitates greater medication use and clinic visits.
High blood pressure, a significant health concern, is closely linked to heart attacks, strokes, and heart failure. Traditionally, the goal has been to maintain systolic pressure under 130 or even 140 mm Hg. However, new research from Mass General Brigham suggests that aiming lower—below 120 mm Hg—offers greater protection and represents a wise health investment.
New Insights from Recent Research
According to the study, “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,” stated researcher Karen Smith, Ph.D., in a news release. The research utilized a simulation model that combined data from reliable sources, including the SPRINT clinical trial, nationwide surveys, and other published findings. The study examined three blood-pressure targets: under 140, under 130, and under 120 mm Hg.
The model accounted for the typical measurement errors that occur in everyday clinical settings. It estimated long-term health outcomes, such as heart attacks, strokes, and heart failure, and weighed these against adverse events from treatment, like falls, kidney damage, low blood pressure, and slow heart rate, along with the added costs of increased medications and clinic visits.
Results and Implications
Even with real-world measurement inaccuracies, targeting a blood pressure below 120 mm Hg proved to prevent more cardiovascular events than the 130 mm Hg goal. The cost per quality-adjusted life-year was calculated to be approximately $42,000, which is considered cost-effective in the U.S. healthcare context.
“This study should give patients at high cardiovascular risk and their clinicians more confidence in pursuing an intensive blood pressure goal,” Dr. Smith emphasized in the news release.
Despite these promising findings, the researchers also noted that achieving these lower blood pressure targets led to increased healthcare spending due to more frequent doctor visits and a higher risk of adverse events related to blood pressure treatment, such as falls, kidney injury, hypotension, and bradycardia.
Determining the Right Candidates
The researchers emphasized the importance of personalized treatment plans. “Our results examine the cost-effectiveness of intensive treatment at the population level,” Dr. Smith explained. “However, given the additional risk of adverse events related to antihypertensives, intensive treatment will not be optimal for all patients. Patients and clinicians should work together to determine the appropriate medication intensity based on patient preferences.”
This development follows a growing trend in personalized medicine, where treatment plans are increasingly tailored to individual patient needs and circumstances. The move represents a shift from a one-size-fits-all approach to a more nuanced strategy that considers the unique risks and benefits for each patient.
As the healthcare community continues to explore the most effective strategies for managing high blood pressure, the insights from this study could lead to significant changes in clinical practice. The next steps will likely involve further research to refine these strategies and ensure they are implemented in a way that maximizes benefits while minimizing risks for patients.
