Study Highlights the Importance of Lowering Systolic Blood Pressure Targets

While high blood pressure is common, it can ultimately lead to cardiovascular disease and stroke. Many patients with high blood pressure are instructed to eat healthier, exercise more often, and take anti-hypertensive drugs.

Current guidelines state that stage 1 hypertension is defined as systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg. More severe hypertension is defined as systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher, according to the Mayo Clinic.

A new study published by JAMA Cardiology suggests that reducing target systolic pressure could significantly reduce the risk of cardiovascular disease and avoidable mortality. These findings support previous studies that found intensive hypertension management reduced instances of heart attack and stroke among patients without diabetes or stroke.

Included in the new meta-analysis were data from 42 clinical trials, which included 144,220 patients. The mean systolic blood pressure ranged from 114 to 171 mm Hg among patients, according to the study.

The authors discovered significant links between systolic blood pressure and the risk of cardiovascular disease and mortality.

The investigators found that a systolic blood pressure (SPB) in the range of 120 mm Hg to 124 mm Hg was linked to the lowest risk of cardiovascular disease (CVD) and mortality, according to the study.

“Our study indicates that treating patients to reduce SBP below currently recommended targets may significantly reduce risk of CVD and all-cause mortality,” the authors wrote. “These findings support more intensive SBP control among adults with hypertension and suggest the need for revising the current clinical guidelines for management of hypertension.”

The investigators also found that the lowest risk of stroke was at a mean systolic blood pressure of less than 120 mm Hg, according to the study.

Additional clinical trials are needed to explore the effects of intensive blood pressure reduction on patients with chronic kidney disease and dementia. The authors stated that intensive clinical trials are also necessary among patients with diabetes and ischemic stroke, the study concluded.

"These findings support more intensive systolic blood pressure control among adults with hypertension," said researcher Jiang He, MD. "They suggest the need for revising the current clinical guidelines for management of high blood pressure."