- Question
- Does an intensive systolic blood pressure target (<120 mm Hg) reduce cardiovascular morbidity and mortality compared with a standard target (<140 mm Hg) in high-risk hypertensive persons without diabetes?
- Design
- Randomized, single-masked trial enrolling 9361 participants. It was stopped early after a median follow-up of 3.26 years because of a lower rate of the primary outcome in the intensive group.
- Population
- Persons with a systolic blood pressure of 130 mm Hg or higher and increased cardiovascular risk, without diabetes.
- Intervention
- Intensive antihypertensive treatment aiming for a systolic pressure <120 mm Hg; most participants started on two-drug therapy, with drugs added and titrated at each visit.
- Control
- Standard treatment aiming for a systolic pressure <140 mm Hg, with therapy intensified only when pressure exceeded predefined thresholds.
- Primary outcome
- Composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes.
- Results
- At 1 year, mean systolic pressure was 121.4 mm Hg with intensive treatment and 136.2 mm Hg with standard treatment. The primary outcome occurred at 1.65% per year vs. 2.19% per year (HR 0.75; 95% CI 0.64 to 0.89; P<0.001). All-cause mortality was also lower with intensive treatment (HR 0.73; 95% CI 0.60 to 0.90; P=0.003).
- Safety
- The intensive group had more serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls.
- Conclusion
- In high-risk patients without diabetes, targeting a systolic pressure <120 mm Hg lowered major cardiovascular events and all-cause death compared with <140 mm Hg, at the cost of more adverse events.
- Why it matters
- It provided strong evidence supporting tighter blood pressure targets in high-risk hypertensive patients without diabetes and reignited debate on treatment goals, weighing benefit against adverse effects.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026