Best Science Medicine Podcast - BS without the BS
Jun 8, 2026 · 25 min · 11 segments
In episode 623, Jamie and James invite Samantha Moe back again to talk about the never-ending debate as to what is the target for systolic blood pressure. We look at the evidence and then try to put…
Samantha MoeGuest
Jamie FalkHostNo entities detected.
Uh, so we wanted to know what the benefits and harms are of lower systolic blood pressure targets.
Um, so we kind of looked at all the evidence and did a search to see what was out there.
Um, but we focused on one particular one that was a meta-analysis of six of the largest randomized controlled trials.
Um, and this was a meta-analysis that was done using participant-level data, so that's also a bit of an advantage.
Um, and the average age was 64, and about 45% of them had a 10-year cardiovascular risk that was over-- that was 20% or more.
And what they wanted to do in these trials was to compare, like, intensive blood pressure control versus more standard blood pressure control.
And intensive was defined as, like, a systolic blood pressure of less than 120 to 130, um, whereas standard was described as a systolic blood pressure of less than 140 to 150.
And, and e- even-- and I know that you guys, y- you have a range there, and even that in and of itself makes it very difficult to figure out exactly what's going on, 'cause there's a big difference of trying to get someone to 120 versus 130.
And, and that's the nuance, and we're gonna-- we'll spend a little bit of time talking about that, uh, particular issue.
But so what we're now comparing is, uh, in, in m- many older guidelines, the target was to get under 140, sometimes 150.
And they found that in the intensively treated group, they had a lower risk of cardiovascular death, so 1.1% versus 1.5% in the standard group.
Uh, so we wanted to know what the benefits and harms are of lower systolic blood pressure targets.
Um, so we kind of looked at all the evidence and did a search to see what was out there.
Um, but we focused on one particular one that was a meta-analysis of six of the largest randomized controlled trials.
Um, and this was a meta-analysis that was done using participant-level data, so that's also a bit of an advantage.
Um, and the average age was 64, and about 45% of them had a 10-year cardiovascular risk that was over-- that was 20% or more.
And what they wanted to do in these trials was to compare, like, intensive blood pressure control versus more standard blood pressure control.
And intensive was defined as, like, a systolic blood pressure of less than 120 to 130, um, whereas standard was described as a systolic blood pressure of less than 140 to 150.
And, and e- even-- and I know that you guys, y- you have a range there, and even that in and of itself makes it very difficult to figure out exactly what's going on, 'cause there's a big difference of trying to get someone to 120 versus 130.
And, and that's the nuance, and we're gonna-- we'll spend a little bit of time talking about that, uh, particular issue.
But so what we're now comparing is, uh, in, in m- many older guidelines, the target was to get under 140, sometimes 150.
And they found that in the intensively treated group, they had a lower risk of cardiovascular death, so 1.1% versus 1.5% in the standard group.
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