Table of Contents
The new study
A new study reinforces why the medical approach to lowering heart attack risk is changing — and the good news is that it doesn't have to require medications to start making a meaningful difference.
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 is possible to change [1].
There's an important question, however, that medicine hasn't had a clear answer to yet: what's the right target for blood pressure for this group? How low should the aim be? Previous studies have given conflicting evidence [1].
Researchers designed this new study to find out what the right target should be. They conducted a randomised trial at 145 clinical sites across China. It involved over 12,000 participants aged 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 group, medications were used to try to get blood pressure below the aggressive target of 120. For the other group, the traditional target of 140 was used. Researchers followed up with participants for up to 5 years [1].
The aim was 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 the question. The old target appears to be no longer good enough. Aggressively lowering blood pressure is critical for cardiovascular health, so long as it's done safely. The evidence points to several important steps for both monitoring and lowering blood pressure — and most of them don't require a prescription.
The revision
It's worth putting 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 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 a reading — up to 140 was perfectly fine. Many patients have been told: as long as blood pressure is under 140 over 90, they're in the clear. The prevailing view was: "120/80 is ideal, but 140 is still okay, right?"
The reason doctors thought 140 was fine is that blood pressure tends to go up as people age, so they assumed a little higher was normal. But new research shows that even that small extra pressure can cause major problems.
The first major wake-up call came from the SPRINT study — the Systolic Blood Pressure Intervention Trial. This study was massive, with 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. The design was quite similar to the newer 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 particularly striking — the results were so clear that researchers 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 substantial difference. There was a 27% lower risk of having a heart attack, stroke, or dying from these causes each year [2].
When it came to death rates alone, there was a 25% lower risk of dying in the group that aimed for 120 [2].
A 25% reduction in the risk of death by lowering blood pressure more aggressively is not a marginal improvement — it's a meaningful clinical finding that changes how blood pressure should be managed.
But the evidence 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, with an even bigger and more varied cast. And 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 is clear: the old "normal" of 140 is no longer good enough. Most adults should aim for a systolic blood pressure of less than 120 to meaningfully protect cardiovascular health.
At-home BP measurement
Something tricky about blood pressure is that most people 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?
It might seem simple to just rely on blood pressure checks at the doctor's office. But there are two problems with that approach.
The first is that people often feel nervous in a clinical setting. This can elevate blood pressure above what's normal for that person — a phenomenon so common it even has a name: "White-coat hypertension."
The most accurate blood pressure measurements come in a familiar environment where a person feels relaxed — like at home. That's why most expert panels recommend patients get at-home blood pressure measurements to confirm any elevated reading obtained in a clinical setting.
There's a second reason why relying solely on blood pressure checks at the doctor's office might not be the best strategy — and that's frequency. Think about it: how often does the average person visit a doctor in a normal year? Probably not that often. Ideally, blood pressure should be monitored more regularly, especially if someone is actively taking steps to lower it. That way, it becomes clear what's working and what isn't.
Both of these reasons make at-home blood pressure monitoring an important tool for anyone focused on understanding and managing their cardiovascular health.
Choosing the right device matters. Look for something that is easy to use and — most importantly — has been tested by an independent agency to ensure accurate results.
The iHealth Track, available on Amazon for under $40.00, is one option that has been independently tested and found to meet the validation standards set by the European Society of Hypertension, making it suitable for use in the general population [5].
It's simple to use and understand, and pairs with a companion smartphone app that makes it easy to keep track of measurements over time — allowing patterns to be spotted and progress to be measured against lifestyle changes.
Given the significance of blood pressure for cardiovascular health and the clear benefits of being able to monitor it conveniently and accurately at home, an at-home blood pressure monitor represents one of the more practical and affordable investments for staying on top of a key health metric. For under $40, it provides ongoing visibility into a number that has an enormous impact on long-term health.
Reducing high BP
If blood pressure is above the 120 target, there are several evidence-backed, non-medication strategies that can help bring it down. Here are some of the most impactful.
1. Reduce sodium intake
One of the simplest strategies is reducing salt intake. The American Heart Association recommends no more than about 1/2 teaspoon (or 1,500 milligrams) per day — compared with the 3,500 milligrams the average American consumes daily.
How significant is sodium intake? One study that analysed 85 different trials found a clear pattern: as sodium intake goes up, so does blood pressure [6].
The mechanism is straightforward. Sodium causes the body to retain more water, increasing blood volume. Greater fluid volume in the blood vessels raises pressure — similar to the way a balloon stretches tighter and tighter as more air is blown into it.
A salt substitute is a practical option for some people looking to reduce sodium without completely sacrificing flavour.
2. Follow the DASH diet
The second strategy for controlling blood pressure is shifting dietary patterns. Researchers have developed guidelines called the DASH diet — which stands for "Dietary Approach to Stop Hypertension." As the name suggests, it's specifically designed to lower blood pressure.
One analysis that compared several types of interventions for lowering blood pressure concluded the DASH diet may be the most effective non-medication approach [7].
The DASH diet is straightforward: choose vegetables, fruits, low-fat dairy, whole grains, chicken, fish, and nuts, while minimising sweets, sugary drinks, and red meat. It's high in fibre, high in lean protein, and packed with micronutrients.
An added benefit of the DASH diet is its natural impact on potassium intake. Potassium-rich foods — spinach, bananas, peas, and beans — are staples of this eating pattern. Potassium helps lower blood pressure by balancing sodium levels and encouraging blood vessel walls to relax.
3. Add regular physical activity
Exercise is a third key strategy for reducing blood pressure. Even small changes can make a meaningful impact, especially for those who have been relatively inactive.
One accessible approach is what researchers call "exercise snacks" — short bursts of physical activity spread throughout the day, rather than a single long training session. This format lowers the barrier to getting started and can fit into most schedules without requiring a gym membership or large blocks of time.
The evidence consistently supports the idea that regular, consistent movement — even in short increments — contributes to meaningful cardiovascular improvements over time.
4. Address excess weight
For those carrying excess weight, weight loss can be a powerful contributor to getting elevated blood pressure under control. Research shows that the greater the weight loss, the greater the reduction in blood pressure [8].
Fortunately, making the dietary and activity changes described above will often support weight loss as a secondary benefit — reinforcing the compounding value of these lifestyle interventions working together.
For those whose weight remains above target despite lifestyle changes, medications such as GLP-1 receptor agonists (e.g. semaglutide) are an additional tool available in consultation with a healthcare provider. Using medication when appropriate is not a failure — it's another strategy for reaching important health targets.
5. Consider blood pressure medication when appropriate
If lifestyle factors are fully addressed, weight is at a healthy level, and systolic blood pressure still remains above 120, the evidence supports a conversation with a healthcare provider about blood pressure medications. The research is clear that medication is best viewed as an addition to — not a replacement for — the lifestyle strategies above. Both approaches working together deliver the strongest cardiovascular protection.
Reference list
- https://www.nejm.org/doi/full/10.1056/NEJMoa2412006
- https://www.nejm.org/doi/10.1056/NEJMoa1901281
- https://pubmed.ncbi.nlm.nih.gov/38945140/
- https://www.who.int/news-room/fact-sheets/detail/hypertension
- https://pmc.ncbi.nlm.nih.gov/articles/PMC6444211/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055199/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7792371/
- https://www.uptodate.com/contents/image?imageKey=NEPH%2F60178&topicKey=PC%2F3852&source=see_link
