Systolic BP Target of <120 mm Hg Reduces CV Event Risk, According to New Data from AHA Scientific Sessions 2023

In patients with hypertension (HTN) at high risk of cardiovascular disease (CVD), an intensive 3-year intervention to lower systolic blood pressure (SBP) to <120 mm Hg reduced the risk of major vascular events and deaths, compared to the standard treatment target of SBP <140 mm Hg, according to new data presented at the American Heart Association’s (AHA) Scientific Sessions 2023, held November 11-13, in Philadelphia, PA.¹

Specifically, the results of the open-label ESPRIT clinical trial showed that in participants with HTN and at high risk for CVD, the intensive 3-year treatment targeting SPB <120 mm Hg resulted in a 12% lower incidence of major vascular events, 39% lower cardiovascular (CV) mortality, and 21% lower all-cause mortality than the standard treatment targeting SBP <140 mm Hg.¹

“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,” said lead author Jing Li, MD, PhD, director, Department of Preventive Medicine, National Center for Cardiovascular Diseases, Beijing, China, in an AHA press release. “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.”²

Li and colleagues recruited adults aged ≥50 years, with an average baseline 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.¹

The primary outcome was a composite of myocardial infarction (MI), coronary or noncoronary revascularization, hospitalization/emergency department visit for heart failure, stroke, or CV death. Secondary outcomes included CV, kidney, and cognitive outcomes. The CV outcomes included components of the primary composite outcome, all-cause death, and a composite of the primary outcome or all-cause death, according to the abstract.¹

From September 2019 to July 2020, a total of 11 255 participants from 116 sites in China were randomly assigned to either intensive treatment or standard treatment.¹

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, according to the AHA statement.²

The median age of the cohort was 64.6 years, 41.3% were women, 28.9% had coronary artery disease, 26.9% had a history of stroke, and 26.9% had diabetes.¹

As mentioned previously, researchers found that 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.¹

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. Another adverse event used to evaluate safety was syncope, which researchers found occurred at a rate of 0.4% per year in the intensive treatment group and 0.1% in the standard treatment group.²

A limitation of the study is its setting in China, limiting the ability to generalize the findings to other racial and ethnic groups or persons in other countries, however, the results were consistent with similar studies with more diverse cohorts, according to the AHA release.²

Future studies will examine longer-term effects of the intensive treatment strategy over the follow-up period of 3.4 years.²

References:

1. Li J, Liu F. Effects of intensive blood pressure lowering treatment in reducing risk of cardiovascular events. Abstract presented at AHA Scientific Sessions 2023; November 11-13, 2023; Philadelphia, PA.

2. Reducing systolic blood pressure to less than 120 mm Hg reduced cardiovascular event risk. News release. American Heart Association. November 13, 2023. Accessed November 14, 2023. https://newsroom.heart.org/news/reducing-systolic-blood-pressure-to-less-than-120-mm-hg-reduced-cardiovascular-event-risk