Research presented today suggests that high-risk patients should aim for a systolic blood pressure of 120 mmHg or lower to better protect against cardiovascular events and death. This finding is central to the OPTIMAL studies, which focused on two groups: individuals with diabetes and patients who have suffered an ischemic stroke or transient ischemic attack.
The OPTIMAL-STROKE study, published in the New England Journal of Medicine, enrolled 4,368 patients from 30 centers across the country. All participants had high blood pressure and a history of an ischemic stroke or transient ischemic attack. The study revealed that a systolic blood pressure reading of 130/80 mmHg is not acceptable for those at the highest risk.
New Blood Pressure Targets for High-Risk Patients
The OPTIMAL studies indicate that for individuals at elevated risk, the maximum acceptable systolic blood pressure—the top number in a reading, representing the pressure when the heart beats—should be 120 mmHg. This lower target is crucial for reducing the risk of further cardiovascular problems and mortality. The research shows that current targets may not be sufficient for this vulnerable population.
Aggressive Control Reduces Stroke Risk
Dr. Gisele Sampaio, a neurologist and leader of clinical trials at Einstein, clarified a common misconception: high blood pressure increases the risk of not only hemorrhagic strokes but also ischemic strokes. The latter, which account for 80% of all strokes, occur when blood flow to the brain is blocked. The question we didn’t know until now was if lowering diastolic pressure below 120 mmHg would help prevent a new stroke in someone who has already had one
, she stated. The OPTIMAL-STROKE research directly addresses this question by demonstrating the benefits of more aggressive blood pressure management.
Groups Received Different Blood Pressure Targets
In the OPTIMAL-STROKE trial, participants were randomized into two groups. One group received standard treatment targeting a systolic blood pressure just below 140 mmHg, while the other was part of the aggressive control group aimed at reaching the lower target of 120 mmHg.
