October 28.2025: How Low Should We Go? | JACC This Week

Dr. Harlan Krumholz introduces a JACC issue unified around the question of how low to target blood pressure, highlighting growing evidence that aiming near 120 mm Hg improves cardiovascular outcomes without harming quality of life. Several studies from the STEP and ESPRIT trials show that intensive blood pressure control widens retinal arterioles, lowers stroke risk, enhances well-being, and remains safe even in older adults. Long-term follow-up data demonstrate that early initiation of intensive therapy provides lasting cardiovascular protection, while new analyses using the PREVENT equations confirm that higher-risk patients gain the most absolute benefit. The issue underscores that intensive control is both safe and effective, and that the next challenge is implementing these proven strategies consistently in clinical practice.