Why Blood Pressure Below 120 Systolic Matters More Than You Think

Full analysis

Peter Attia reviews the SPRINT trial (2015), which randomized about 10,000 people with systolic blood pressure of 130 or higher to either an intensive target below 120 or a standard target below 140. The intensive group saw roughly a 25% relative reduction in major cardiovascular events and a 27% reduction in all-cause mortality — an absolute risk difference of about 1.2 percentage points — over a median follow-up of just over three years, at which point the trial was stopped early because the benefit was so clear. A 2021 Chinese trial called STEP, with about 8,500 participants aged 60–80, replicated the cardiovascular finding with a 26% relative reduction in cardiovascular outcomes and a 28% reduction in cardiovascular death. Current guidelines classify blood pressure below 120/80 as normal, 120–129 over less than 80 as elevated, 130–139 or 80–89 as Stage 1 hypertension, and 140 or higher or 90 or higher as Stage 2. About 46% of U.S. adults meet the criteria for hypertension under these definitions, and by age 75 the prevalence exceeds 80% for both sexes.