Key result
Intensive SBP control to <120 mm Hg yields modest HRQoL benefits in high-risk patients.
Why the study?
Does intensive blood pressure-lowering treatment (target SBP <120 mm Hg) improve health-related quality of life in hypertensive patients with high cardiovascular risk compared to standard treatment (target SBP <140 mm Hg)?
RCT (n=10,804)
Open-label, blinded-outcome
Randomly assigned
Does intensive blood pressure-lowering treatment (target SBP <120 mm Hg) improve health-related quality of life in hypertensive patients with high cardiovascular risk compared to standard treatment (target SBP <140 mm Hg)?
Intensive blood pressure lowering to <120 mm Hg provides a modest but statistically significant improvement in health-related quality of life compared to standard targets in high-risk hypertensive patients.
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Reassures clinicians adopting intensive BP targets in high-risk hypertension; extends randomized evidence to patient-centered HRQoL outcomes.[[1]](https://www.jacc.org/doi/full/10.1016/j.jacc.2025.06.
BACKGROUND: Cumulative evidence supports the beneficial effects of intensive blood pressure (BP)-lowering treatment to prevent cardiovascular events and death; however, the effects of a more aggressive BP target on health-related quality of life (HRQoL) remain unclear. OBJECTIVES: This study aimed to compare the effects of intensive vs standard BP-lowering treatment strategies on long-term change in HRQoL among hypertensive patients with high cardiovascular risk. METHODS: The ESPRIT (Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing Risk of Vascular Events) trial was an open-label, blinded-outcome, randomized controlled trial. Participants were randomly assigned to receive either intensive BP-lowering treatment (targeting standard office systolic blood pressure [SBP] to <120 mm Hg) or standard BP-lowering treatment (targeting office SBP to <140 mm Hg). HRQoL was assessed by using the 5-level EuroQol Five Dimensions Questionnaire (EQ-5D-5L) at baseline and the final follow-up visit. Covariance analyses were applied to evaluate the effect of treatment assignment on changes in HRQoL. RESULTS: The current study included 5,398 participants in the intensive treatment group and 5,406 participants in the standard treatment group. Over 3.4 years of follow-up, the EQ-5D visual analog scale scores increased by 0.56 point in the intensive treatment group and decreased by 0.50 point in the standard treatment group, resulting in a mean difference of 1.26 (95% CI: 0.55 to 1.98; P < 0.001). Compared with the standard treatment, the intensive treatment was associated with a 16% higher likelihood of meaningful improvement than worsening in EQ-5D visual analog scale (relative risk: 1.16; 95% CI: 1.04-1.30; P = 0.007). Categorical changes from baseline to the final follow-up visit in 5 domains between the 2 groups showed no statistical differences. CONCLUSIONS: Intensive BP treatment, targeting office SBP to <120 mm Hg, produced modest benefits to HRQoL among hypertensive patients with high cardiovascular risk. (Effects of Intensive Systolic Blood Pressure Lowering Treatment in Reducing Risk of Vascular Events [ESPRIT]; NCT04030234).
Huang et al. (2025) conducted an RCT in Hypertension with high cardiovascular risk (n=10,804). Intensive BP-lowering treatment vs. Standard BP-lowering treatment (targeting office SBP to <140 mm Hg) was evaluated on Change in EQ-5D visual analog scale scores (MD 1.26, 95% CI 0.55 to 1.98, p=< 0.001). Intensive blood pressure-lowering treatment (SBP <120 mm Hg) modestly improved health-related quality of life compared to standard treatment (mean difference 1.26; 95% CI 0.55-1.98; P<0.001).
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