While I was in my GP office finishing off some paperwork for the day, I came across a new study that reinforces why doctors like me needed to change our approach to how we lower a person’s heart attack risk. The best news is that it doesn’t have to require medications.
Table of Contents
The new study
Let’s start with the new study’s findings.
The researchers were investigating blood pressure in older people with Type 2 diabetes. Why this group? High blood pressure is the most common health problem in people with Type 2 diabetes. It elevates their risks of heart disease but it’s something that’s possible to change [1].
There’s an important question, however, that we haven’t had a clear answer to yet. What’s the right target for blood pressure for this group? How low should we aim for? Previous studies have given conflicting evidence [1].
Researchers designed this new study to find out what the right target should be. So here’s what they did. They conducted a randomized trial at 145 clinical sites across China. It involved over 12,000 participants 50 and over with Type 2 diabetes, elevated blood pressure, and an increased risk of heart disease [1].
Patients were divided into two groups. For one, they used medications to try to get their blood pressure below the aggressive target of 120. For the other group, they used a traditional target of 140. They followed up with participants for up to 5 years [1].
They wanted to see how the different blood pressure targets affected risks for things like heart attacks and strokes.
The results were eye opening. The group that had the more aggressive target of 120 had a 21% lower risk of heart attacks, strokes, heart failure, and death from heart disease [1].
It was a pretty clear answer to their question. It’s time for the old target to be thrown out the window. Aggressively lowering blood pressure is critical for our health, so long as it’s done safely. And in a moment, I’m going to detail the most important steps we can take to both monitor and lower our blood pressure.
The revision
But first, I want to put this study in a broader context. Because it's not only about people with Type 2 diabetes. This is just one more piece of evidence supporting a major revision in how doctors like me think about high blood pressure for everyone.
For a long time, doctors believed that having a systolic blood pressure — that's the top number on your reading — up to 140 was perfectly fine. You may have even heard your doctor say that as long as your blood pressure is under 140 over 90 you're in the clear. We used to think, “Okay, 120/80 is ideal, but 140? That’s still okay, right?”
The reason doctors thought 140 was fine is that blood pressure tends to go up as we get older, so they figured a little higher was normal. But new research shows even that little extra pressure can cause major problems.
The first wake-up call came from the SPRINT study, which stands for the Systolic Blood Pressure Intervention Trial. This study was massive—over 9,000 participants—so the findings are hard to ignore.
The goal was to see if lowering blood pressure to below 120 would protect against heart attacks, strokes, and other problems better than using the older target of 140. So the design was quite similar to the new study focused on people with Type 2 diabetes.
The people in the SPRINT study were at high risk for heart disease, but they didn’t have diabetes or a history of stroke. They were split into two groups: One aimed for a blood pressure below 140, and the other aimed for less than 120.
Here’s where it gets really interesting—the results were so clear that they had to stop the study early!
The study was supposed to last 4–6 years, but after just 3.3 years, it was obvious that lowering blood pressure to below 120 made a huge difference. There was a 27% lower risk of having a heart attack, stroke, or dying from these causes each year [2].
And when it came to death rates alone, there was a 25% lower risk of dying in the group that aimed for 120 [2].
Let that sink in for a moment—a 25% reduction in the risk of death just by lowering blood pressure more aggressively. This isn’t a small improvement; it’s a game-changer.
But the story doesn’t stop there. Recently, another study in China tested these findings on an even larger and more diverse group—over 11,000 people. And it included those with diabetes and those who had already had a stroke.
Think of this study as a sequel to the SPRINT study but with an even bigger cast. And guess what? The results were just as powerful.
Lowering systolic blood pressure to less than 120 reduced the risk of heart attacks, strokes, and death from cardiovascular causes by 12% [3].
Plus, it cut the overall risk of death from any cause by 21% over three and a half years [3].
The takeaway from these studies was clear: the old 'normal' of 140 is no longer good enough. Most of us should aim for a systolic blood pressure of less than 120 to really protect our health.
At-home BP measurement
Something tricky about blood pressure is that we aren’t automatically aware of it. Many don’t know it’s high until it’s too late [4]. So what’s the best way to stay on top of it and avoid surprises?
You might be thinking, “Simple. I get my blood pressure checked when I go to the doctor.” But there are two problems with that approach.
The first is that people often get nervous at the doctor’s office. This can elevate blood pressure above what’s normal for the person. This is a problem that’s so common it even has a name: “White-coat hypertension.”
You’ll get the most accurate blood pressure measurement when you’re in a familiar environment where you feel relaxed — like at home. That’s why most expert panels recommend patients get at-home blood pressure measurements to confirm a high blood pressure reading they had at the doctor’s office.
There’s a second reason, though, why relying on measuring your blood pressure at the doctor’s office might not be your best strategy—and that’s frequency. Think about this: How often do you
visit the doctor in a normal year? Probably not that often. Ideally, you want a way to monitor your blood pressure more regularly, especially if you are actively taking steps to try to lower it. That way, you can see what’s working and what isn’t.
Both of these reasons are why I always recommend to my patients that they get a device for monitoring their blood pressure at home.
You need to be careful when choosing a device, however. Look for something that’s easy to use and, most importantly, has been tested by an independent agency to ensure that the results you’ll get are accurate.
My top pick is the iHealth Track, available on Amazon for under $40.00.
A study found that it met the standards set by the European Society of Hypertension and is suitable for use in the general population [5].
It’s simple to use and understand and even lets you keep track of your measurements with a companion app for your phone.
Given the significance of your blood pressure for your health and the benefits of being able to monitor it conveniently and accurately at home, this could be the best $40 you ever spend on your well-being.
Reducing high BP
But what if our blood pressure is above that 120 target? The good news is that there are several natural ways to bring it down without medication. Here are some of the most impactful actions we can take.
One of the simplest is to reduce our salt intake. The American Heart Association recommends that we have no more than about 1/2 teaspoon (or 1,500 milligrams) per day. Compare that with the 3,500 milligrams the average American eats daily.
How significant is sodium intake? One study that looked at 85 different trials found a clear pattern: as sodium intake goes up, so does blood pressure [6].
The reason is simple. Sodium causes your body to retain more water, increasing the volume of your blood. If there is a greater amount of fluid in your blood vessels, it makes sense that the pressure would increase. It’s similar to the way a balloon stretches tighter and tighter as you blow more air into it.
A salt substitute is a good option for some people.
The second thing we can do to control blood pressure is to shift the way we eat. Researchers have developed guidelines called the DASH diet, which stands for “Dietary Approach to Stop Hypertension.” As you can tell from the name, it’s specifically designed to lower blood pressure.
One analysis looked at several types of interventions to lower blood pressure. It concluded the DASH diet might be the most effective way to lower blood pressure without using medications [7].
The DASH diet is simple. Choose vegetables, fruits, low-fat dairy, whole grains, chicken, fish, and nuts, while minimizing consumption of sweets, sugary drinks, and red meat. It’s high fiber, high lean protein, and packed with nutrients.
As an added bonus, when we follow the DASH diet, we’re also more likely to increase our intake of potassium through potassium-rich foods like spinach, bananas, peas, and beans.
Why is this a bonus? Because potassium helps lower blood pressure. It balances out sodium levels while encouraging the walls of our blood vessels to relax.
The third key strategy to reduce blood pressure is adding exercise. I know how hard it can seem to get started, especially if you have been relatively inactive.
Thankfully, even small changes can make a positive impact. I encourage my patients to start where they are and look for ways to add movement into their schedules. I recommend they try exercise snacks. They’re short bursts of physical activity that you sprinkle throughout your day—like mini-workouts instead of one long training session.
I do an exercise snack during my 15-minute paperwork breaks at the clinic.
Finally, for overweight individuals, weight loss can be a powerful contributor to getting elevated blood pressure under control. One study showed that the greater the weight loss, the greater the reduction in blood pressure [8].
Fortunately, though losing weight can be challenging, making the changes we’ve talked about so far will make this much easier.
But if our weight is above target, despite optimizing our lifestyle factors, we can consider medications such as Ozempic to help on our weight loss journey. Taking medication isn’t a failure—it’s another tool to help reach our health goals.
And finally, if our lifestyle factors are dialed in, weight is perfect, but we still have a blood pressure above 120, then I have a discussion with my patients about the pros and cons of blood pressure medications. Medication should be an addition to, not a replacement for, all the other steps.
Reference list
1. https://www.nejm.org/doi/full/10.1056/NEJMoa2412006
2. https://www.nejm.org/doi/10.1056/NEJMoa1901281
3. https://pubmed.ncbi.nlm.nih.gov/38945140/
4. https://www.who.int/news-room/fact-sheets/detail/hypertension
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC6444211/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055199/
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC7792371/
8. https://www.uptodate.com/contents/image?imageKey=NEPH%2F60178&topicKey=PC%2F3852&source=see_link
