Lowering systolic blood pressure below 120 mm Hg may prevent more cardiovascular problems than higher treatment goals, according to new research.
While the stricter target carried a higher risk of side effects and greater medical costs, the benefits outweighed the drawbacks. The study also showed that the lower goal was cost-effective, even when accounting for typical errors in readings.
Aggressive Blood Pressure Control Shows Promise
A team from Mass General Brigham reports that the potential health benefits of stricter blood pressure management appear to outweigh the risks of overtreatment. Their findings come from a simulation study recently published in the Annals of Internal Medicine.
To carry out the analysis, researchers drew on information from the Systolic Blood Pressure Intervention Trial (SPRINT), the National Health and Nutrition Examination Survey (NHANES), and other scientific sources. They modeled long-term health outcomes, such as heart attack, stroke, and heart failure, for patients treated to three different systolic blood pressure goals: <120 mm Hg, <130 mm Hg, and <140 mm Hg. Because blood pressure medications can cause side effects, the study also examined the likelihood of serious complications linked to treatment.
The model further incorporated the types of reading errors that commonly occur during everyday clinical measurements.
Benefits and Risks of Lower Targets
Even after adjusting for these errors, the results showed that aiming for a systolic blood pressure below 120 mm Hg prevented more cardiovascular events than the 130 mm Hg goal. However, this more aggressive target also came with added risks, including falls, kidney injury, low blood pressure (hypotension), and a slow heart rate (bradycardia). In addition, the intensive target increased overall healthcare costs because of greater medication use and more frequent medical visits.
When the three targets were compared for cost-effectiveness under typical measurement conditions, the <120 mm Hg goal was still favorable. The researchers estimated it provided good value, with an associated cost of $42,000 per quality-adjusted life-year gained.
Expert Perspective on Intensive Treatment
“This study should give patients at high cardiovascular risk and their clinicians more confidence in pursuing an intensive blood pressure goal,” said lead author Karen Smith, PhD, an investigator at the Department of Orthopedic Surgery at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “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.”
Smith also cautioned, “Our results examine the cost-effectiveness of intensive treatment at the population level. 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.”
Reference: “Effect of Systolic Blood Pressure Measurement Error on the Cost-Effectiveness of Intensive Blood Pressure Targets” by Karen C. Smith, Thomas A. Gaziano, Alvin I. Mushlin, David M. Cutler, Nicolas A. Menzies and Ankur Pandya, 18 August 2025, Annals of Internal Medicine.
DOI: 10.7326/ANNALS-25-00560
In addition to Smith, Mass General Brigham authors include Thomas Gaziano. Additional authors include Alvin Mushlin, David Cutler, Nicolas Menzies, and Ankur Pandya.
The study was funded by the National Science Foundation and the National Institute of Neurological Disorders and Stroke.
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2 Comments
Just starting out.
Very interesting