Is there any benefit to more intensive blood pressure (BP) targets than recommended in existing guidelines?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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It should be noted that, aside from the ADA guidelines, existing guideline recommendations on target BP goals were developed prior to the Systolic Blood Pressure Intervention Trial (SPRINT) study, an NIH sponsored trial that demonstrated a 25% decrease in cardiovascular events or death with targeting a systolic BP less than 120 mm Hg versus 140 mm Hg in patients at increased cardiovascular risk. [133]  These intriguing results suggest a benefit from more-intensive BP targets than are recommended in existing guidelines. However, the generalizability of the SPRINT results remain unclear. Importantly, the SPRINT trial excluded patients with diabetes mellitus or prior cerebrovascular accident. These populations have been studied previously in the ACCORD and SPS3 trials, respectively, which failed to demonstrate significant benefits to stringent BP targets of below 120-130 mm Hg. [90, 134]

It is also important to recognize that the SPRINT trial utilized an automatic oscillometric office BP method without human participation, which typically yields a systolic BP that is 7-10 mm Hg lower than the standard office-based BP used in most studies. [109]  This suggests that the lower systolic BP target in the SPRINT trial may be closer to more moderate targets in other studies, and that stringent systolic BP targeting of 120 mm Hg in standard clinical practice may increase the rate of adverse events such as hypotension, electrolyte abnormalities, and acute kidney injury. [133, 135]

A large meta-analysis of hypertension studies that tested systolic BP targets (including the SPRINT trial) demonstrated a reduction in cardiovascular outcomes and overall mortality with a systolic BP target below 130 mm Hg, although the magnitude of the benefit decreased with BP goals progressively below 150 mm Hg. [136]  Future guidelines will likely incorporate the results of the SPRINT trial into target BP recommendations, which may result in lower target BPs, at least for patients with high cardiovascular risk but without diabetes or prior cerebrovascular accidents. 

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