How high should blood pressure be to reduce cardiovascular risks?

This study evaluated the optimal targets of blood pressure (BP) in older patients. It found that lowering systolic BP (SBP; BP when the heart beats) to 110-130 mmHg resulted in a lower risk of heart attack, stroke, or death compared to maintaining an SBP of 130-150 mmHg.

High blood pressure is a well-known risk factor for major cardiovascular events (MACEs). A MACE includes strokes, heart attacks, or death due to heart disease. However, it is not clear how much BP should be lowered in order to reduce this risk as much as possible, particularly in older patients.

8,511 patients aged 60-80 participated in this study. Patients were divided into two groups. Group 1 was treated to achieve an SBP target of 110-130 mmHg. Group 2 was treated to achieve an SBP target of 130-150 mmHg.  Patients were followed up for an average of 3.34 years to monitor for heart attacks, strokes, and death.

After one year of treatment, the average SBP in group 1 was 127.5 mmHg, compared to 135.3 mmHg in group 2. After 3.34 years of follow-up heart attacks, strokes or death occurred in 3.5% of group 1 patients, and 4.6% of group 2 patients. Overall the risk of heart attack, stroke, or death was 26% lower in group 1 than in group 2.

Side effects such as dizziness, loss of consciousness, fractures, headache, swelling, and hives were similar between groups. However, more patients in group 1 (3.4%) had low BP compared to group 2 (2.6%).

This study showed that aiming for a lower blood pressure in older patients led to a reduced risk of heart attack, stroke, and death. 

This study involved Asian patients only. Further studies are needed to determine if these results apply to other ethnicities as well.

Speak to your physician about what level of blood pressure you should aim for to reduce your risk of complications.