Recent research from General Brigham suggests that aiming for more aggressive blood pressure management may have greater health benefits than previously thought. The results of this study indicate that the benefits of more intensive blood pressure lowering may outweigh concerns about overtreatment of hypertensive patients. This result is Annual report of internal medicine.
To better understand the impact of different treatment goals, researchers analyzed data from the Systolic Blood Pressure Intervention Trial (SPRINT), the National Health and Nutrition Examination Survey (NHANES), and other published studies. They used this information to model lifetime health outcomes such as heart attack, stroke, and heart failure in patients with systolic blood pressure goals of less than 120 mm Hg, less than 130 mm Hg, and less than 140 mm Hg.
Because blood pressure medications can cause side effects, the researchers also assessed the risk of serious complications related to treatment. Their model included both the potential benefits of preventing cardiovascular events and the potential harms associated with drug use.
Accounting for real-world measurement errors
The researchers also incorporated common inaccuracies in blood pressure measurements into their analysis. These errors reflect those commonly seen in daily clinical practice and can impact treatment decisions and outcomes.
Benefits and risks of intensive blood pressure management
Even after accounting for these real-world measurement errors, the model showed that targeting systolic blood pressure below 120 mm Hg prevented more cardiovascular events than targeting 130 mm Hg. This includes reductions in heart attacks, strokes, and heart failure.
However, more aggressive targets are not without drawbacks. Patients were more likely to experience treatment-related side effects such as falls, kidney damage, hypotension, and bradycardia. Additionally, pursuing lower goals increased overall health care costs due to increased use of antihypertensive medications and increased frequency of physician visits.
Cost-effectiveness of blood pressure lowering targets
Despite the additional risks and costs, researchers found that a target of less than 120 mm Hg remains cost-effective when compared with higher targets under typical conditions. The estimated cost was $42,000 per quality-adjusted life year, a measure of value commonly used in the medical field.
Experts consider treatment policy
“This study should give patients at high cardiovascular risk and their clinicians more confidence to pursue targeted blood pressure goals,” said lead author Dr. Karen Smith, a research fellow in the Department of Orthopedics at Brigham and Women’s Hospital and a founding member of the Massachusetts General Brigham Health System. “Our findings suggest that a strong target of less than 120 mm Hg prevents more cardiovascular events and provides good value. This is true even when measurements are not perfect.”
Smith emphasized that these findings apply to a population level and may not be appropriate for all individuals. “Our results examine the cost-effectiveness of intensive treatment at a population level. However, given the additional risk of adverse events associated with antihypertensive drugs, intensive treatment may not be optimal for all patients. Patients and clinicians should work together to determine the appropriate dosage intensity based on the patient’s preferences.”
Study authors and funding
In addition to Smith, other authors of Mass General Brigham include Thomas Gaziano. Other contributors to this research include Alvin Mushlin, David Cutler, Nicolas Menzies, and Ankur Pandya.
This research was funded by the National Science Foundation and the National Institute of Neurological Disorders and Stroke.
