Two studies provide additional support for lowering systolic blood pressure to an intensive goal of 120 mmHg – far below the standard guidelines of 140 mmHg – to reduce the risk of heart disease in high–risk patients with hypertension. The new research shows that intensive blood pressure control is well–tolerated by patients and is cost–effective in terms of health–related quality of life and financial costs to the healthcare system.

Published online in the New England Journal of Medicine on Aug. 24, the findings address ongoing debates that have been simmering since results from the Systolic Blood Pressure Intervention Trial (SPRINT) were first reported nearly two years ago.

“Intensive blood pressure control improves health outcomes in high–risk patients, but it has been unclear whether the approach is cost–effective or if it’s well–tolerated by patients compared to standard control,” says Adam Bress, PharmD, MS, an assistant professor of Population Health Sciences at University of Utah Health who co–led the first, cost–effectiveness study. Bress explains that treatment would not be sustainable in clinical practice if, for instance, it makes patients feel miserable or comes with an exorbitant price tag.

“Collectively, these results provide strong evidence that intensive control is worth considering in high–risk patients,” says Bress.

On average, patients on intensive therapy often took three to four anti–hypertensive medications to reach the lower blood pressure goal, raising concerns that side effects such as light–headedness, dizziness, or fatigue could make the regimen difficult to tolerate.

The second study examined health–related quality of life by having the 9,631 SPRINT participants – about half of whom were on intensive therapy – answer standard questionnaires assessing their quality of life, physical and mental health, and satisfaction with their care during the clinical trial. Participants on intensive therapy reported feeling as well as those receiving standard blood pressure control and were equally satisfied with their care. They were also just as likely to maintain their medication regimen, another indication that the treatment was well–tolerated. A subpopulation considered particularly vulnerable to side effects from intensive therapy, frail participants age 75 and older, also fared well under the intensive approach. Frail, older participants began at lower measures of physical and cognitive abilities,” explains Mark Supiano, MD, a co–author on both studies and a geriatrician at University of Utah Health and VA Salt Lake City Health Care System. A total of 2,560 SPRINT participants were in this category.

Importantly, intensive blood pressure control did not further decrease quality of life measures compared to standard control even in frail, older adults,” says Supiano. Additional studies are being carried out to determine the long–term impacts of treatment.

The research was published as two papers titled: “Cost–Effectiveness of Intensive vs. Standard Blood Pressure Control” and “Impact of Intensive Blood Pressure Therapy on Patient–Reported Outcomes.”