A new study suggests that lowering systolic blood pressure well under the current recommendations could further reduce heart disease and early death in many people with hypertension.

If you have high blood pressure (hypertension) and take medication to lower it, how low should you aim to get your blood pressure?

The current recommendation is to lower blood pressure to below 130/80 mm Hg. But going lower might be even better. According to one study¹, lowering the systolic blood pressure (the first number) to below 120 could further reduce heart disease and early deaths in many people with hypertension.

The study’s findings aren’t a formal recommendation. And while a lower target may sound like a good idea, there are some difficulties and risks for patients who aim so low.

It can be hard to reach the lower goal. People in the study aiming for a systolic pressure below 120 had to take three drugs on average. Achieving the older target took only two drugs.

The more intensive treatment caused about twice as many side effects, too, including:

• Dizziness
• Fainting
• Electrolyte abnormalities
• Reversible kidney damage

While probably beneficial, dropping below 120 mm Hg can itself be dangerous. If you decide to aim low, stay alert to how you feel. If you get dizzy or feel faint, tell your doctor, since it may be a sign that your blood pressure is too low. Fainting and dizziness can of course result in dangerous falls.

Going below 110 is even riskier. A study² of patients being treated for hypertension found that the 27% whose systolic blood pressure dropped below 110 mm Hg at one or more medical visits during a one-year period were twice as likely to experience a serious fall or fainting episode as patients whose treated blood pressure was above 110 at all visits.

There is no one-size-fits-all treatment for people with hypertension. Many factors can affect treatment decisions about blood pressure. These factors include:

• Age
• Overall health
• Heart health
• Other medications

If you are being treated for hypertension and are at higher risk for heart disease, talk to your doctor about the potential benefits and risks of a lower treatment goal.

The best option is still to lower your blood pressure by making lifestyle changes. These include:

• Losing excess weight
• Quitting smoking
• Exercising
• Moderating your alcohol intake
• Improving your diet

 

Reference:

1. Systolic Blood Pressure Intervention Trial (SPRINT). New England Journal of Medicine, November, 2015.
2. John J. Sim. American Journal of Preventive Medicine, October, 2018.