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Blood Pressure: How Low Should You Go?

 Geir Pettersen/Getty Images
Geir Pettersen/Getty Images,

by Sarah Mahoney

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Doctors have long treated high blood pressure, the most common chronic disease in the U.S., with medication and lifestyle changes. Usually, they hope to lower systolic blood pressure (the one given first, also known as SBP) to 140 or 150 mmHg. But a large new study suggests that many Americans might benefit by reducing that number to 120.

Those are the results of the just-released Systolic Blood Pressure Intervention Trial, a collaborative investigation between the University of Utah, University of Alabama at Birmingham, and Columbia University. More than 9,300 participants, aged 50 to 75, with an elevated risk for cardiovascular disease, blood pressure of at least 130, no diabetes, and no stroke history, were assigned a target of either 140 SBP or lower, or 120 SBP or lower. They were given hypertensive medication and coached in healthy nutrition and exercise, then monitored for three years

People whose blood pressure was reduced to 120 saw the risk for stroke, heart attack and heart failure decrease by 24 percent.

Systolic Blood Pressure Intervention Trial

The results were powerful. People whose blood pressure was reduced to 120 saw the risk for stroke, heart attack, and heart failure decrease by 24 percent. The risk of death fell 27 percent.

While new guidelines could be months or years away, researchers say anyone who is 50 or older, has BPS higher than 130, and meets the same criteria for those included in the research should pay heed. The study did turn up some serious risks, including hypotension, fainting, and acute kidney abnormalities. (So far, none of the kidney damage seems permanent.)

This is potentially big news for the one in three American adults who struggle with hypertension.

“The positive results of this trial have taken most investigators by surprise, and the strong benefits of treatment seem to outweigh the risks,” writes Alfred Cheung, M.D., chief of nephrology & hypertension at University of Utah Health Care, and co-author on the study. Researchers say the benefits may be even greater beyond the three-year study period. 

Meanwhile, here’s what you can do now to build healthy habits:

Know your numbers. While 120 is considered optimal, 120 to 139 is pre-hypertensive, 140 to159 is Stage I hypertension, and 160 or higher Stage 2. Current treatment guidelines suggest that people 50 and older lower their rate to 140 or below, and those 60 and older to 150 and below.

Talk to your doctor. Blood pressure medications are safe and effective; your physician can choose the best one for you.

Clean up your act. Maintaining a healthy body weight, eating well, exercising, avoiding tobacco and managing stress all play an important role.