TOPLINE:

More than 60% of patients with hypertension and a high cardiovascular risk achieved intensive control of blood pressure (BP) targeting systolic BP (SBP) < 120 mm Hg, including those with long-standing uncontrolled hypertension.

METHODOLOGY:

• Researchers analyzed data from a multicenter, open-label, randomized controlled trial (ESPRIT)to assess the feasibility of an intensive target of SBP (< 120 mm Hg). They included 11,255 patients with hypertension and a high cardiovascular risk (mean age, 64.6 years; 41.3% women).
• Patients were randomly assigned to either the intensive arm with an SBP target < 120 mm Hg or the standard arm with an SBP target < 140 mm Hg. Local physicians titrated medications, and a set of free essential antihypertensive drugs were provided.
• Patients were classified into four groups by short- and long-duration hypertension (< 10 years vs ≥ 10 years) and controlled and uncontrolled hypertension (< 140 mm Hg vs ≥ 140 mm Hg).
• Researchers assessed the achieved average SBP level, time to achieve intensive control, medication use, frequency of clinic visit, major vascular events, all-cause death, and safety outcomes.
• Patients were followed up for up to 3 years, with monthly visits during the first 3 months for dose titration and quarterly visits thereafter.

TAKEAWAY:

• The intensive arm achieved a median of achieved average SBP level of 117 mm Hg, and 62.5% of patients achieved sustained control of SBP < 120 mm Hg. Men, older patients, individuals with higher baseline SBP levels, and patients with a history of diabetes were less likely to achieve intensive BP control (P < .05 for all).
• Among patients who achieved sustained intensive control, the median time to reach SBP < 120 mm Hg was 62 days, and more than 60% reached the target within 3 months.
• At 1 year, patients in the intensive and standard arms used a medication equivalent of 3.3 and 2.0, respectively, and had a frequency of 6.9 and 5.4 clinic visits in year one, respectively.
• Over 3 years, the intensive arm appeared to have a lower risk for major vascular events and death than the standard arm. Most treatment effects were similar across patients with controlled vs uncontrolled baseline BP and those with short- vs long-duration hypertension. 

IN PRACTICE:

“Given the high prevalence and low control rate of hypertension worldwide, most hypertensive patients are exposed to BPs higher than 140 mm Hg. We provide evidence to dismiss physicians’ and patients’ concerns that targeting SBP <120 mm Hg is impossible, unnecessary, or even harmful for these patients,” the researchers of the study wrote.

SOURCE:

The study was led by Yue Peng, Yan Li, MD, and Shitian Li, of the National Center for Cardiovascular Diseases in Beijing, China. It was published online on April 01, 2026, in JACC.

LIMITATIONS:

The duration of hypertension was self-reported. The mean BP at screening or randomization was assumed to reflect long-term BP, which may have been inaccurate. The trial was open-label, conducted only in China, and subgroup analyses were post hoc and underpowered.

DISCLOSURES:

The study received funding from multiple sources including the China Academy of Chinese Medical Sciences Innovation Fund for Medical Science, National High-Level Hospital Clinical Research Funding from Fuwai Hospital, and National Key Research and Development Program from the Ministry of Science and Technology of China. Free drugs were provided by Changzhou Siyao Pharmaceuticals Co Ltd, Shanghai Shyndec Pharmaceutical Co Ltd, Tianjin Lisheng Pharmaceutical Co Ltd, and Servier (Tianjin) Pharmaceutical Co Ltd. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.