Four studies presented at the 36th Great Wall International Congress of Cardiology/Asian Heart Society Congress 2025 (GW-ICC/AHS.25) and simultaneously published in JACC examined the effects of intensive blood pressure (BP) lowering in certain populations, on the retinal microvasculature and more.

In JACC, results from the ESPRIT trial showed that intensive BP treatment, targeting office systolic BP (SBP) <120 mm Hg, produced modest benefits to long-term change in health-related quality of life (QOL) among high-risk cardiovascular patients with hypertension. According to Xinghe Huang, PhD, et al., this open-label, blinded-outcome, randomized trial showed that intensive BP treatment did not worsen QOL, with no trade-off between patients' well-being and clinical outcomes.

"Our findings contribute to the understanding of the effects on [health-related QOL] of targeting SBP to <120 mm Hg in a diverse population and provide complementary evidence to support the wide application" of this strategy, they write.

Yuan Lu, DSc, FACC, and John A. Spertus, MD, MPH, FACC, refer to these findings as an "important tool for conversations with patients" in an accompanying editorial comment. "The modest but favorable effects of intensive BP control on [health-related QOL] highlight the importance of systematically incorporating patient-reported outcomes into hypertension trials and guidelines," they write.

In another study published in JACC, a prespecified secondary outcome analysis of the ESPRIT trial conducted by Bin Wang, PhD, et al., found that lowering SBP using intensive treatment with a target of <120 mm Hg compared with standard treatment with a target of <140 mm Hg for three years has a positive impact on retinal microvasculature. The study provides the first evidence that interventions such as this may improve systemic microcirculation and mitigate hypertension-mediated organ damage among high-risk cardiovascular patients.

"...direct evidence for the retinal microvasculature is lacking," according to Wang, et al. "Although recent studies have shed light on the beneficial treatment of intensive BP-lowering treatment on the heart, brain and peripheral artery, this is the first study to reliably assess a new major organ system: retinal microvasculature."

In an accompanying editorial comment, Mathieu F. Bakhoum, MD, PhD, et al., note two main reasons these findings matter. "First, they provide the strongest randomized evidence to date that driving SBP into the 120 mm Hg range can likely reverse microvascular injury, at least in the eye and plausibly in microvascular beds of other organs. Second, they turn retinal imaging into a practical monitoring tool..."

Results from an extended follow-up of the STEP trial, also published in JACC, suggest that during long-term follow-up, sustained intensive BP control may benefit older patients (60-80 years) with hypertension when compared with delayed intensive treatment. According to Qirui Song, MD, PhD, "the earlier intensive treatment is initiated after the hypertension diagnosis, the greater the cardiovascular benefits will be."

Paul Muntner, PhD, and C. Barrett Bowling, MD, write that this study "provides important new data supporting intensive SBP lowering in older adults" in an accompanying editorial comment. Muntner and Bowling emphasize that "it is time for health systems, clinicians and patients to adopt this evidence-based SBP goal."

Catherine G. Derington, PharmD, MS, and colleagues conducted a secondary analysis of the SPRINT trial using PREVENT equations to compare standard vs. intensive BP control for primary prevention. Also published in JACC, the study found that the relative risk reduction with intensive vs. standard SBP treatment was consistent across the PREVENT risk strata among SPRINT participants without baseline cardiovascular disease. Of note, absolute treatment benefits varied several fold across groups. "These findings underscore the utility of PREVENT to identify those most likely to derive substantial absolute benefit from intensive SBP control for primary prevention," write Derington, et al.

Additionally, a brief JACC report on a post-hoc analysis of the SPRINT trial, conducted by Yuzhe Yin, MD, found that cardiovascular-kidney-metabolic disease does not significantly modify the efficacy of intensive BP control. However, the authors note that greater mortality benefits were found in stage 4 patients.