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TOPLINE:

In patients with hypertension and high cardiovascular risk, an intensive blood pressure (BP) treatment targeting systolic BP lower than 120 mm Hg produced modest but significant improvements in health-related quality of life (HRQOL) compared with standard treatment targeting BP lower than 140 mm Hg.

METHODOLOGY:

• The ESPRIT trial, conducted at 116 sites in China, found a reduced risk for major vascular events and death with intensive BP-lowering treatment compared with standard treatment. However, an aggressive target and more medications raised concerns about QOL.
• Researchers analyzed data from the ESPRIT trial to compare the effects of intensive and standard BP-lowering treatment on HRQOL in patients with office systolic BP between 130 and 180 mm Hg and high cardiovascular risk.
• They included 10,804 patients aged 50 years or older (mean age, 64.6 years; 41% women). Of them, 5398 were randomly assigned to receive intensive treatment and 5406 to standard treatment, with all followed up for a median duration of 3.36 years.
• Patients reported their HRQOL at baseline and final follow-up using the EuroQol Five-Dimensions Five-Level Questionnaire (EQ-5D-5L) and a visual analog scale of 0-100, with higher scores indicating a better health status.
• An increase of seven or more points on the EQ-5D visual analog scale was considered a clinically meaningful improvement. The EQ-5D utility index reflected societal perspective in health analysis.

TAKEAWAY:

• Mean scores on the EQ-5D visual analog scale increased by 0.56 points in the intensive treatment group and decreased by 0.50 points in the standard treatment group (mean difference, 1.26; P < .001).
• Intensive treatment was associated with a 16% higher likelihood of a meaningful improvement on the EQ-5D visual analog scale than worsening (relative risk, 1.16; P = .007).
• Mean EQ-5D utility index scores decreased in both groups, but the decline was smaller with intensive treatment (mean difference, 0.010; P = .011).
• Benefits were consistent across subgroups, irrespective of age, sex, baseline BP, frailty status, and baseline HRQOL.

IN PRACTICE:

“The current study findings provide strong evidence to dispel the concern about HRQOL worsening caused by intensive BP-lowering treatment and help clinicians make patient-centered decisions,” the researchers wrote.

“In addition to emphasizing the well-known benefits for reducing cardiovascular events, we can now reassure patients that treatment intensification is unlikely to worsen their quality of life, and may actually improve it,” experts wrote in an accompanying editorial.

SOURCE:

This study was led by Xinghe Huang, PhD, of Chinese Academy of Medical Sciences in Beijing, China. It was published online on October 16, 2025, in Journal of the American College of Cardiology.

LIMITATIONS:

HRQOL was measured only at baseline and at the end of study, without capturing any transient changes during follow-up. About 4% of patients in each group did not report HRQOL at the final visit. Many patients (63%) had the maximum EQ-5D utility score at baseline, which may have limited detection of further improvement.

DISCLOSURES:

This study received support from multiple sources including China Academy of Chinese Medical Sciences Innovation Fund for Medical Science, the National Key Research and Development Program from the Ministry of Science and Technology of China, and the National Clinical Research Center for Cardiovascular Disease. The trial received free drugs from Changzhou SIYAO Pharmaceutical, Shanghai Shyndec Pharmaceutical, Tianjin Lisheng Pharmaceutical, and Servier (TIANJIN) Pharmaceutical. One author reported receiving research grants and honoraria from Servier (TIANJIN) Pharmaceutical.

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