Daily Dose: Lowering SBP to <120 mm Hg Reduces CV Event Risk

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study presented at the American Heart Association’s (AHA) Scientific Sessions 2023, held November 11-13, in Philadelphia, PA.

The study

The open-label ESPRIT clinical trial was conducted to evaluate the effects of an intensive blood pressure-lowering strategy on the incidence of major cardiovascular (CV) events, including myocardial infarction (MI), coronary or noncoronary revascularization, hospitalization/emergency department visit for heart failure, stroke, or CV death.

Researchers recruited adults aged ≥50 years, with an average baseline systolic blood pressure (SBP) between 130 mm Hg and 180 mm Hg and at high CV risk (established CVD or ≥2 major CV risk factors). Median follow-up was 3.4 years.

From September 2019 to July 2020, a total of 11 255 participants from 116 sites in China were randomly assigned to either intensive treatment (SBP target <120 mm Hg) or standard treatment (SBP target <140 mm Hg). Antihypertensive medications were provided to participants in both groups, although participants in the intensive treatment arm received higher doses than those in the standard treatment group.

Findings

Compared to standard treatment targeting SBP of <140 mm Hg, intensive treatment to SBP <130 mm Hg was associated with a 12% reduced risk of major vascular events (eg, MI, coronary or noncoronary revascularization), 39% lower risk of CV death, and 21% lower all-cause mortality over 3 years.

Investigators did not observe any significant differences in serious adverse events, including low blood pressure, electrolyte abnormality, fall resulting in injury, and acute renal injury or failure.

Authors' comment

"These results provide evidence that intensive hypertension treatment focused on achieving systolic blood pressure of less than 120 mm Hg is beneficial and safe for individuals with high blood pressure and increased cardiovascular risk factors. Implementing this intensive treatment strategy for high-risk adults has the potential to save more lives and reduce the public health burden of heart disease worldwide."

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