Blood Pressure Treatment Target

Researchers have long debated the optimal blood pressure for people older than age 50, especially in older adults who might not tolerate lower blood pressure. Alfred Cheung, MD, and colleagues at University of Utah Health led one of five national Clinical Center Networks to design and conduct the Systolic Blood Pressure Intervention Trial (SPRINT). They examined whether targeting a systolic blood pressure below 120 mm Hg would improve health outcomes compared to targeting systolic blood pressure below 140 mm Hg, previously considered the standard target. Cheung and colleagues found that intensive blood pressure lowering led to a 25% decrease in major cardiovascular events and all-cause mortality. Adam Bress, PharmD and colleagues determined that the intervention was economically cost-effective and its benefits extended to people over 75 years old and to individuals with underlying kidney disease or prediabetes, without significant side effects. Secondary analyses showed that intensive blood pressure lowering decreased risks of cognitive impairment, including in older adults. This landmark study led to new clinical practice guidelines and changed perceptions of the risk/benefit ratio of intensive blood pressure control in older adults.