# Intensive systolic blood-pressure lowering (target below 120 mm Hg) Intervention · id `cardio:intensive-sbp-lowering` · Cardiovascular Atlas · release `2b2017b84496b985` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Browse, organ or system: Blood vessels Browse, condition area: High blood pressure ## In plain language A treatment plan that adjusts blood-pressure medicines until the top number is under 120, rather than the more usual under 140. ## Technical summary Treat-to-target antihypertensive strategy with a systolic goal below 120 mm Hg, as tested in SPRINT. It is a strategy, not a specific drug. ## Claims, with the population each applies to ## Context: Adults 50 and over with raised systolic blood pressure and increased cardiovascular risk, without diabetes or prior stroke (SPRINT) Recipient: Adult; Population: Adults aged 50 years or older with systolic blood pressure of 130 to 180 mm Hg (the registry lowers the upper limit as the number of blood-pressure medicines rises) and at least one increased-risk criterion, excluding diabetes mellitus and prior stroke.; Care setting: Outpatient trial clinics at 102 clinical sites. Nursing-home and assisted-living residents were not enrolled.; Geography: United States, including Puerto Rico; Life stage: Adult, 50 years and over (28.2% of each arm aged 75 or over, per Table 1 of the paper); Follow-up: Median follow-up 3.26 years when the blood-pressure intervention was stopped early on 2015-08-20. The registry gives a planned maximum follow-up of 6 years. Mean systolic pressure at 1 year was 121.4 mm Hg (intensive) and 136.2 mm Hg (standard). ### In the same trial and time window, fewer people in the lower-target group died from any cause: 155 of 4678 versus 210 of 4683 (hazard ratio 0.73, 95% CI 0.60 to 0.90). - Category: Effect - Evidence stage: Interventional - Certainty: Certainty not assessed - Applies to: Recipient: Adult; Population: Adults aged 50 years or older with systolic blood pressure of 130 to 180 mm Hg (the registry lowers the upper limit as the number of blood-pressure medicines rises) and at least one increased-risk criterion, excluding diabetes mellitus and prior stroke.; Care setting: Outpatient trial clinics at 102 clinical sites. Nursing-home and assisted-living residents were not enrolled.; Geography: United States, including Puerto Rico; Life stage: Adult, 50 years and over (28.2% of each arm aged 75 or over, per Table 1 of the paper); Follow-up: Median follow-up 3.26 years when the blood-pressure intervention was stopped early on 2015-08-20. The registry gives a planned maximum follow-up of 6 years. Mean systolic pressure at 1 year was 121.4 mm Hg (intensive) and 136.2 mm Hg (standard). - Limitations: Secondary outcome. The limits of the primary-effect claim also apply: one open-label trial stopped early for benefit, results the authors do not extend to people with diabetes, prior stroke or age under 50, or to nursing-home residents, and a 2017 erratum whose content was not verified. - Last checked: Not recorded - Source problem: a cited source is corrected. Check the sources before relying on this claim. - Sources: 1. Supports: A Randomized Trial of Intensive versus Standard Blood-Pressure Control (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record.) Locator: Abstract, RESULTS, sentence 3: "All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003).". Retrieved 2026-10-09T15:56:27Z. Source state: Corrected. Snapshot hash: 0469472c893c84018c2444c15e0a5337926968dadfdd96ad3771f84a69c4e40c. How it applies: Abstract of the primary report, for the same population and follow-up as this context. 2. Supports: A Randomized Trial of Intensive versus Standard Blood-Pressure Control (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record.) Locator: Results, Clinical outcomes, para 2: "155 in the intensive-treatment group and 210 in the standard-treatment group". Retrieved 2026-10-09T15:57:07Z. Source state: Corrected. Snapshot hash: 14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6. How it applies: PMC author manuscript, not the version of record. 3. Supports: A Randomized Trial of Intensive versus Standard Blood-Pressure Control (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record.) Locator: Table 2, "All participants" header row: "All participants (N = 4678) (N = 4683)". Retrieved 2026-10-09T15:57:07Z. Source state: Corrected. Snapshot hash: 14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6. How it applies: PMC author manuscript, not the version of record. 4. Background: A Randomized Trial of Intensive versus Standard Blood-Pressure Control (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record.) Locator: Discussion, para 7: "persons with diabetes, those with prior stroke, and those younger than 50 years of age". Retrieved 2026-10-09T15:57:07Z. Source state: Corrected. Snapshot hash: 14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6. How it applies: The groups to whom the authors say the results do not generalize. 5. Background: Erratum to "A Randomized Trial of Intensive versus Standard Blood-Pressure Control" (Publication, edition PubMed publication type "Published Erratum". The erratum text was not reachable (HTTP 403) and the PubMed record has no abstract.) Locator: PubMed record of the 2017 erratum (PMID 29262284); the record has no text. Retrieved 2026-10-09T15:57:08Z. Source state: Current. Snapshot hash: 0b35286e25986a2083bf5e24855520256cee0d8b58ccbff94f1f70961857ff34. How it applies: Shows that a correction exists. What it changes, and whether it affects these numbers, is unknown. ### In SPRINT, adults aged 50 and over at raised heart risk, without diabetes or a past stroke, whose treatment aimed for a top (systolic) blood pressure below 120 mm Hg had fewer major heart and blood-vessel events than those aiming for below 140. Over a median of 3.26 years, 243 of 4678 people in the lower-target group and 319 of 4683 in the standard group had a first primary-outcome event (hazard ratio 0.75, 95% CI 0.64 to 0.89). - Category: Effect - Evidence stage: Interventional - Certainty: Certainty not assessed - Applies to: Recipient: Adult; Population: Adults aged 50 years or older with systolic blood pressure of 130 to 180 mm Hg (the registry lowers the upper limit as the number of blood-pressure medicines rises) and at least one increased-risk criterion, excluding diabetes mellitus and prior stroke.; Care setting: Outpatient trial clinics at 102 clinical sites. Nursing-home and assisted-living residents were not enrolled.; Geography: United States, including Puerto Rico; Life stage: Adult, 50 years and over (28.2% of each arm aged 75 or over, per Table 1 of the paper); Follow-up: Median follow-up 3.26 years when the blood-pressure intervention was stopped early on 2015-08-20. The registry gives a planned maximum follow-up of 6 years. Mean systolic pressure at 1 year was 121.4 mm Hg (intensive) and 136.2 mm Hg (standard). - Limitations: One open-label trial; outcome adjudicators did not know the assignment. The blood-pressure intervention was stopped early for benefit after crossing a monitoring boundary. The authors say the results do not generalize to people with diabetes, prior stroke or age under 50, or to nursing-home residents. The paper and the registry word the older-age entry criterion differently ("75 years or older" versus "greater than 75 years"), and this is not reconciled. The publication has a 2017 erratum whose content was not verified. Full-text figures come from the PMC author manuscript. - Last checked: Not recorded - Source problem: a cited source is corrected. Check the sources before relying on this claim. - Sources: 1. Supports: A Randomized Trial of Intensive versus Standard Blood-Pressure Control (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record.) Locator: Abstract, RESULTS, sentence 2: "hazard ratio with intensive treatment, 0.75; 95% confidence interval \[CI\], 0.64 to 0.89; P<0.001". Retrieved 2026-10-09T15:56:27Z. Source state: Corrected. Snapshot hash: 0469472c893c84018c2444c15e0a5337926968dadfdd96ad3771f84a69c4e40c. How it applies: Abstract of the primary report, for the same population and follow-up as this context. 2. Supports: A Randomized Trial of Intensive versus Standard Blood-Pressure Control (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record.) Locator: Results, Clinical outcomes, para 1: "243 (1.65% per year) in the intensive-treatment group and 319 (2.19% per year) in the standard-treatment group". Retrieved 2026-10-09T15:57:07Z. Source state: Corrected. Snapshot hash: 14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6. How it applies: PMC author manuscript, not the version of record. 3. Supports: A Randomized Trial of Intensive versus Standard Blood-Pressure Control (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record.) Locator: Table 2, "All participants" header row: "All participants (N = 4678) (N = 4683)". Retrieved 2026-10-09T15:57:07Z. Source state: Corrected. Snapshot hash: 14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6. How it applies: PMC author manuscript, not the version of record. 4. Supports: Systolic Blood Pressure Intervention Trial (SPRINT) (Registry, edition Record as of the last update submitted 2020-12-11 and posted 2021-01-08. First posted 2010-09-21 (marked estimated). Results first posted 2017-12-04.) Locator: resultsSection, primary outcome measure (posted results 243 of 4678 and 319 of 4683; HR 0.75, 0.64 to 0.89). Retrieved 2026-10-09T15:56:28Z. Source state: Current. Snapshot hash: 67c6195a32189455b608076fe2b490395dc14cc6e8bec40006e9a817b7f6d0ae. How it applies: The registry posted results equal the paper's figures. 5. Background: A Randomized Trial of Intensive versus Standard Blood-Pressure Control (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record.) Locator: Methods, Study population, para 1: "or an age of 75 years or older". Retrieved 2026-10-09T15:57:07Z. Source state: Corrected. Snapshot hash: 14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6. How it applies: Paper wording of the older-age criterion. 6. Background: Systolic Blood Pressure Intervention Trial (SPRINT) (Registry, edition Record as of the last update submitted 2020-12-11 and posted 2021-01-08. First posted 2010-09-21 (marked estimated). Results first posted 2017-12-04.) Locator: eligibilityModule.eligibilityCriteria: "Age greater than 75 years". Retrieved 2026-10-09T15:56:28Z. Source state: Current. Snapshot hash: 67c6195a32189455b608076fe2b490395dc14cc6e8bec40006e9a817b7f6d0ae. How it applies: Registry wording of the older-age criterion differs from the paper and is not reconciled. 7. Background: A Randomized Trial of Intensive versus Standard Blood-Pressure Control (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record.) Locator: Discussion, para 7: "persons with diabetes, those with prior stroke, and those younger than 50 years of age". Retrieved 2026-10-09T15:57:07Z. Source state: Corrected. Snapshot hash: 14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6. How it applies: The groups to whom the authors say the results do not generalize. 8. Background: Erratum to "A Randomized Trial of Intensive versus Standard Blood-Pressure Control" (Publication, edition PubMed publication type "Published Erratum". The erratum text was not reachable (HTTP 403) and the PubMed record has no abstract.) Locator: PubMed record of the 2017 erratum (PMID 29262284); the record has no text. Retrieved 2026-10-09T15:57:08Z. Source state: Current. Snapshot hash: 0b35286e25986a2083bf5e24855520256cee0d8b58ccbff94f1f70961857ff34. How it applies: Shows that a correction exists. What it changes, and whether it affects these numbers, is unknown. ### Some serious side effects were more common with the lower target: serious adverse events of low blood pressure, fainting, abnormal blood salt levels (electrolytes), and sudden kidney injury or failure. Serious falls causing injury were not more common. - Category: Safety - Evidence stage: Interventional - Certainty: Certainty not assessed - Applies to: Recipient: Adult; Population: Adults aged 50 years or older with systolic blood pressure of 130 to 180 mm Hg (the registry lowers the upper limit as the number of blood-pressure medicines rises) and at least one increased-risk criterion, excluding diabetes mellitus and prior stroke.; Care setting: Outpatient trial clinics at 102 clinical sites. Nursing-home and assisted-living residents were not enrolled.; Geography: United States, including Puerto Rico; Life stage: Adult, 50 years and over (28.2% of each arm aged 75 or over, per Table 1 of the paper); Follow-up: Median follow-up 3.26 years when the blood-pressure intervention was stopped early on 2015-08-20. The registry gives a planned maximum follow-up of 6 years. Mean systolic pressure at 1 year was 121.4 mm Hg (intensive) and 136.2 mm Hg (standard). - Limitations: Event counts and rates are in Table 3 and supplementary tables of the paper, which were not extracted. In an open-label trial, participants and study staff knew the assignment when adverse events were recorded. The 2017 erratum content was not verified. - Last checked: Not recorded - Source problem: a cited source is corrected. Check the sources before relying on this claim. - Sources: 1. Supports: A Randomized Trial of Intensive versus Standard Blood-Pressure Control (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record.) Locator: Abstract, RESULTS, sentence 4: "Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher". Retrieved 2026-10-09T15:56:27Z. Source state: Corrected. Snapshot hash: 0469472c893c84018c2444c15e0a5337926968dadfdd96ad3771f84a69c4e40c. How it applies: Abstract of the primary report, for the same population and follow-up as this context. 2. Background: A Randomized Trial of Intensive versus Standard Blood-Pressure Control (Publication, edition Version of record not fetched (HTTP 403). The abstract comes from PubMed (electronic article date 2015-11-09). Full-text facts come from the PMC author manuscript PMC4689591, which PMC marks as not the version of record.) Locator: Methods, Randomization and interventions, para 1: "Participants and study personnel were aware of the study-group assignments, but outcome adjudicators were not.". Retrieved 2026-10-09T15:57:07Z. Source state: Corrected. Snapshot hash: 14488a091a5a65b94db2789887ceff8e32d3c89d79db5656553e4429adf44be6. How it applies: PMC author manuscript, not the version of record. 3. Background: Erratum to "A Randomized Trial of Intensive versus Standard Blood-Pressure Control" (Publication, edition PubMed publication type "Published Erratum". The erratum text was not reachable (HTTP 403) and the PubMed record has no abstract.) Locator: PubMed record of the 2017 erratum (PMID 29262284); the record has no text. Retrieved 2026-10-09T15:57:08Z. Source state: Current. Snapshot hash: 0b35286e25986a2083bf5e24855520256cee0d8b58ccbff94f1f70961857ff34. How it applies: Shows that a correction exists. What it changes, and whether it affects these numbers, is unknown. ## Connected pages - A specific, lower target: Blood-pressure lowering to a target (`cardio:bp-lowering-to-target`) - Evaluated in SPRINT, in adults 50 and over without diabetes or prior stroke: Hypertension (high blood pressure) (`core:hypertension`) [a claim, not a settled fact; see claim `cardio:claim-sprint-primary-effect` and its context] - Investigated in: Systolic Blood Pressure Intervention Trial (SPRINT) (`cardio:sprint`) ## Provenance Content hash: becbbaa34e2c3583752034e9cfc3f86e6078d60710f15580e8c7396440198588 Last substantive edit: 2026-10-09 Evidence last checked: Not recorded