Systolic blood pressure under 130 may cut heart risk in people over 60

A clinical-trial analysis suggests that keeping systolic blood pressure below 130 may reduce the chance of major cardiovascular problems in adults older than 60. The results add to the discussion over how strictly blood pressure should be managed in later life.

Systolic blood pressure is the upper number in a reading. It shows the pressure in the arteries when the heart contracts. When it stays high, it can slowly harm blood vessels and raise the risk of stroke, heart attack and heart failure.

To reach their conclusions, researchers pooled results from six clinical trials using a Bayesian network meta-analysis. This method makes it possible to compare different treatment targets even when the studies did not test every target head-to-head.

The team looked at older adults whose treated systolic pressure was below 130 millimeters of mercury, between 130 and 139, or 140 and above. The main focus was on major cardiovascular events.

People in the below-130 group had fewer serious heart-related events than those whose systolic pressure was 140 or higher. The benefits included lower rates of stroke, heart attack and heart failure.

The findings appeared in Cardiovascular Innovations and Applications. The analysis did not show a clear difference among the blood pressure groups in deaths from cardiovascular disease or from any cause.

That difference matters, because reducing nonfatal heart events is not the same as proving that a treatment target helps people live longer. Differences in study populations and treatment strategies also make comparisons more complicated.

Older adults are not all the same. Some live with kidney disease, frailty, dizziness or a history of falls, while others remain active and otherwise healthy. More intensive blood pressure treatment may bring different risks for these groups.

Overall, the analysis points to a possible benefit from lower systolic pressure, but it does not establish one ideal target for every person over 60. Decisions still depend on overall health and how well a patient tolerates medication.

Blood pressure is often checked more than once, since a single reading can be influenced by activity, stress or the setting in which it is taken. Clinical trials also vary in how they measure blood pressure and how aggressively treatment is adjusted. Those details matter when comparing targets across studies and help explain why researchers continue to study the trade-off between lower readings and treatment-related side effects.

Further research may help identify which older adults benefit most and how to balance cardiovascular protection with adverse effects. The broader takeaway is that blood pressure targets should reflect both the evidence and individual circumstances.