Key points from article :
Blood-pressure targets have steadily fallen over the past several decades, prompting claims that pharmaceutical companies are driving the change. But historical evidence shows the opposite: early medical texts from the 1940s set the bar for “high” blood pressure extremely high—around 180/110—and only worried about hypertension once it caused visible damage. Yet actuarial data from 1925, based on over 700,000 life-insurance records, had already revealed that elevated blood pressure strongly predicted early death, and the risk rose steadily with each increase in pressure.
Scientific momentum shifted with the launch of the Framingham Heart Study in 1948, which found by 1957 that high blood pressure alone significantly increased the risk of heart disease. This led to the first U.S. guidelines in 1977 and a gradual lowering of thresholds through the 1980s and 1990s. A major 2003 analysis in The Lancet, pooling one million adults, showed that cardiovascular risk continues to drop even below the long-established 140 mmHg cutoff—down to at least 115—suggesting that earlier targets were still too high to be fully protective.
More recent clinical trials have strengthened this picture. The SPRINT trial (New England Journal of Medicine) demonstrated that lowering systolic blood pressure to below 120 rather than 140 reduced the risk of heart attacks, strokes, and cardiovascular death by 27%, and cut overall mortality by 25%. A large trial in China reached similar conclusions across a more diverse population, including people with diabetes and prior stroke. Additional analyses even show cognitive benefits, with lower blood-pressure targets associated with a reduced risk of dementia.
New 2024–2025 guidelines keep the same definitions for elevated blood pressure and hypertension but push for earlier intervention and more ambitious targets—ideally under 120 mmHg for those at higher cardiovascular risk. Lifestyle strategies such as reducing salt intake (including the use of salt substitutes) and achieving at least 5% weight loss play a central role, with medications recommended sooner if goals aren’t met. The article concludes that falling blood-pressure targets are not the result of a conspiracy but of overwhelming evidence that lower pressures offer better protection for the heart, brain, and lifespan.
