Guidelines for Blood Pressure Targets

Updated guidelines released by the National Institute of Health aim for lower blood pressure goals in the management of hypertension. A landmark study revealed that a systolic blood pressure below 120 millimeters of mercury (mm Hg) was more effective at reducing stroke and heart disease than the previously recommended target of 140 mm Hg.

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What This Means for You

Updated recommendations mean that your doctor now has information about ideal blood pressure that is different from the information the medical community had before the latest research study results were available.

In terms of your health, this means that if your systolic blood pressure is above 120 mm Hg, your doctor might modify the dose of your anti-hypertensive medication, might add a new medication, or might change your current medication to a different medication in order to reach the healthy goal.

Why the Guidelines Were Updated

The updated guidelines are based on a landmark study called the SPRINT trial. The SPRINT trial was conducted between 2010 and 2013, involving 9361 patients from 102 different locations throughout the United States.

All participants were diagnosed with hypertension and had a systolic blood pressure between 150 mm Hg and 180 mm Hg at the start of the study. Systolic blood pressure is the higher number in a blood pressure reading. So if your blood pressure is 160/80, then your systolic blood pressure is 160 mm Hg.

The study volunteers were divided into two groups: one group with a target systolic pressure of 140 mm Hg (the standard treatment group) and another group with target systolic pressure of 120 mm Hg (the intensive treatment group.) The initial plan was to monitor the participants approximately every three months for five years.

However, the intensive treatment group did so much better than the standard treatment group that investigators ended the study after a little over three years instead of completing the five-year project. The standard treatment group had a 43% higher rate of death than the intensive treatment group. The intensive blood pressure control with the goal of a systolic blood pressure below 120 mm Hg resulted in fewer deaths from stroke, heart disease, and other medical causes.

How High Blood Pressure Affects Your Stroke Risk

High blood pressure (hypertension) is a condition that is not optimal for normal heart and blood vessel functioning. Hypertension causes cardiovascular disease, which leads to stroke. Hypertension also damages the blood vessels in the brain, causing a condition called cerebrovascular disease, which independently causes strokes and adds to the risk of stroke if you have heart disease.

Therefore, it has been known for some time that hypertension is a stroke risk. However, what is new is that the well-accepted target of 140 mm Hg systolic blood pressure was not low enough to optimally prevent stroke.

Should You Worry About the Side Effects of Intensive Blood Pressure Management? 

There are side effects of low blood pressure. Some participants in both groups in the SPRINT trial had some symptoms of low blood pressure (hypotension) such as lightheadedness, feeling faint, and kidney damage. Patients who had blood pressure goals below 120 mm Hg for systolic blood pressure were slightly more likely to experience side effects of hypotension than the group who had a target of below 140 mm Hg.

Overall, if you have hypertension, you should anticipate a different blood pressure goal than you have had in the past for more effective prevention of stroke and heart disease. While side effects of low blood pressure are not common, it is a good idea to be familiar with the signs and symptoms of hypotension, which are lightheadedness, dizziness, and feeling faint or passing out.

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  1. SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control [published correction appears in N Engl J Med. 2017 Dec 21;377(25):2506]. N Engl J Med. 2015;373(22):2103-2116. doi:10.1056/NEJMoa1511939

  2. National Heart, Lung and Blood Institute. Landmark NIH study shows intensive blood pressure management may save lives. Published September 11, 2015.

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