Episode 462: Before you lower blood pressure to 120, listen to this podcast

In episode 462, James and Mike invite Scott Garrison to talk about some important nuances around guideline recommendations and how low we should lower systolic blood pressure. We look in detail at the SPRINT trial and then come up with a reasonable (in our minds) approach to what thresholds we should use.

Show notes 






U-Shaped Mortality Curves for Systolic BP

1) Clarify Registry

Vidal-Petiot E, Ford I, Greenlaw N, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet. 2016;388(10056):2142-2152.


Bohm M, Schumacher H, Teo KK, et al. Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials. Lancet. 2017;389(10085):2226-2237.

3) Chinese Longitudinal Healthy Longevity Study

Lv YB, Gao X, Yin ZX, et al. Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study. BMJ. 2018;361:k2158.

4) Blood Pressure Trajectories in the 20 Years Before Death

Delgado J, Bowman K, Ble A, et al. Blood Pressure Trajectories in the 20 Years Before Death. JAMA Intern Med. 2018;178(1):93-99.

5) MDRD Trial

Lazarus JM, Bourgoignie JJ, Buckalew VM, et al. Achievement and safety of a low blood pressure goal in chronic renal disease. The Modification of Diet in Renal Disease Study Group. Hypertension. 1997;29(2):641-650

7) ACCORD Trial

Group AS, Cushman WC, Evans GW, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575-1585.

7) SPRINT Main Findings

Group SR, Wright JT, Jr., Williamson JD, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103-2116.

8) SPRINT Ambulatory BP Sub-study

Drawz PE, Pajewski NM, Bates JT, et al. Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study. Hypertension. 2017;69(1):42-50.

9) Concern over SPRINT BP Measurement Technique

Agarwal R. Implications of Blood Pressure Measurement Technique for Implementation of Systolic Blood Pressure Intervention Trial (SPRINT). J Am Heart Assoc. 2017;6(2)

Kjeldsen SE, Mancia G. Unobserved automated office blood pressure measurement in the Systolic Blood Pressure Intervention Trial (SPRINT): systolic blood pressure treatment target remains below 140 mmHg. Eur Heart J Cardiovasc Pharmacother. 2016;2(2):79-80.

10) Comparison of Unobserved Automated Office BP and Ambulatory BP

Seidlerova J, Gelzinsky J, Materankova M, Ceral J, Konig P, Filipovsky J. In the aftermath of SPRINT: further comparison of unattended automated office blood pressure measurement and 24-hour blood pressure monitoring. Blood Press. 2018;27(5):256-261.

Kjeldsen SE, Mancia G. Unattended automated office vs. ambulatory blood pressure in people with high cardiovascular risk: implications for understanding the SPRINT results. J Hypertens. 2019;37(1):6-8.

11) Unattended and Attended SPRINT BP Readings Not Different

Johnson KC, Whelton PK, Cushman WC, et al. Blood Pressure Measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71(5):848-857.

12) Comparison Between SPRINT BP and Primary Care Office BP

Drawz PE, Agarwal A, Dwyer JP, et al. Concordance Between Blood Pressure in the Systolic Blood Pressure Intervention Trial and in Routine Clinical Practice. JAMA Intern Med. 2020.