Aiming for systolic pressure under 120 may avert more heart attacks, study model finds

Keeping systolic blood pressure below 120 could prevent more heart attacks and strokes than less aggressive targets, according to a computer modeling study. The potential gains, however, come with trade-offs, including a higher chance of treatment-related side effects.

Researchers at Mass General Brigham compared three long-term systolic blood pressure goals: under 120, under 130 and under 140 millimeters of mercury. Systolic pressure is the upper number in a blood pressure reading.

Rather than running a new study that would track patients for decades, the team built a simulation based on evidence from earlier research and population data, including findings from the SPRINT trial and national health survey information.

The model estimated how each treatment target might influence cardiovascular events, medical costs and quality of life over time. It also took into account measurement errors that can happen in clinical blood pressure readings.

The most intensive target was projected to avert more serious cardiovascular events than the higher goals. Those events included heart attacks, strokes and heart failure, all of which can lead to lasting disability or death.

At the same time, more intensive treatment can create new problems. The analysis included risks such as dizziness, kidney complications and slower heart rate, along with the added burden of more medication and follow-up monitoring.

The researchers also measured cost-effectiveness using quality-adjusted life-years, a metric that combines lifespan with health-related quality of life. The study estimated a cost of about $42,000 for each additional quality-adjusted life-year.

Based on the model’s assumptions, that suggested the more intensive approach could be cost-effective. But a simulation cannot prove that the same balance of benefits and harms will apply to every patient.

People vary in age, frailty, other illnesses and how well they tolerate blood pressure medicines. For some, low blood pressure or medication side effects may pose greater risks than the average person represented in the model.

The findings point to careful use of lower targets for appropriate patients rather than a one-size-fits-all rule. They also show how preventing cardiovascular disease requires weighing expected benefits against the practical costs of treatment.

A simulation’s strength is that it can examine outcomes over a much longer horizon than most clinical trials. Its limitation is that the conclusions depend on assumptions about treatment effects, patient behavior and the cost of care.

The SPRINT trial offered important evidence on intensive blood pressure control in selected higher-risk adults, but the participants in that study were not identical to every patient treated in routine practice.

As a result, the modeling findings should be viewed as an estimate of what might occur under specific conditions. They add to clinical trial evidence rather than replacing direct observations of patients receiving treatment.

Source: Mass General Brigham.