120 mmHg for everyone

The recently published Systolic Blood Pressure Intervention Trial (SPRINT) casts new light on the issue of lowering blood pressure to 120 mmHg. The trial randomized 9161 patients with systolic blood pressures of 130 mmHg - 180 mmHg and increased cardiovascular risk into a group receiving intensive treatment (target 120 mmHg) and a group given standard treatment (target 140 mmHg). The trial was stopped earlier than foreseen because interim analysis showed a lower incidence rate of myocardial infarction, stroke, heart failure and death from cardiovascular causes in the group given intensive treatment (1.65 versus 2.19 per year, hazard ratio 0.75; 95% CI 0.64-0.89; p < 0.001). These results open up the possibility of aiming for lower blood pressure targets in antihypertensive treatment. It is questionable whether this strategy would be preferred by every patient. New guidelines on cardiovascular risk management should pay more attention to shared decision-making where doctors inform patients about the benefits and risks of strict or less strict blood pressure control and patients choose personal targets.