Mass General Brigham study finds that intensive treatment for elevated blood pressure in patients at high cardiovascular risk is cost-effective

How low should blood pressure go? New study has the answer

Mass General Brigham

Research led by investigators at Mass General Brigham suggests that the health benefits of more aggressive blood pressure control outweigh concerns about overtreating people with high blood pressure readings. Results of the simulation study are published in Annals of Internal Medicine.

The study used data from the Systolic Blood Pressure Intervention Trial (SPRINT) trial, the National Health and Nutrition Examination Survey (NHANES), and other published literature to simulate lifetime health outcomes -- including heart attack, stroke, and heart failure -- for patients whose systolic blood pressure targets were set at <120 mm Hg, <130 mm Hg, and <140 mm Hg. Recognizing that blood pressure medication comes with side effects, the researchers also simulated and compared the risk of serious events resulting from the treatment.

The simulation model also accounted for common errors in patients' blood pressure readings based on what has been observed in routine clinical practice.

Even when including this error rate, the simulation model found the <120 mm Hg target prevented more cardiovascular events, such as heart attacks, strokes, and heart failure than the <130 mm Hg target. However, the lower target led to additional adverse events related to treatment, such as falls, kidney injury, hypotension, and bradycardia. The lower target also increased overall healthcare spending due to increased antihypertensive use and more frequent visits with clinicians.

Comparing the cost-effectiveness of the three blood pressure targets with typical levels of measurement error, the researchers found the <120 mm Hg target was cost-effective, associated with a cost of $42,000 per quality-adjusted life-year gained.

"This study should give patients at high cardiovascular risk and their clinicians more confidence in pursuing an intensive blood pressure goal," said lead author Karen Smith, PhD, an investigator at the Department of Orthopedic Surgery at Brigham and Women's Hospital, a founding member of the Mass General Brigham healthcare system. "Our findings suggest the intensive <120 mm Hg target prevents more cardiovascular events and provides good value, and this holds true even when measurements aren't perfect."

Smith also cautioned, "Our results examine the cost-effectiveness of intensive treatment at the population level. However, given the additional risk of adverse events related to antihypertensives, intensive treatment will not be optimal for all patients. Patients and clinicians should work together to determine the appropriate medication intensity based on patient preferences."

Authorship: In addition to Smith, Mass General Brigham authors include Thomas Gaziano. Additional authors include Alvin Mushlin, David Cutler, Nicolas Menzies, and Ankur Pandya.

Funding: The study was funded by the National Science Foundation and the National Institute of Neurological Disorders and Stroke.