Is There A Sweet Spot For Systolic Blood Pressure Control?

Dr. John J. Sim Division of Nephrology and Hypertension Kaiser Permanente Los Angeles Medical Center, Los Angeles, Interview with:
Dr. John J. Sim
Division of Nephrology and Hypertension
Kaiser Permanente Los Angeles Medical Center, Los Angeles,

Medical Research: What are the main findings of the study?

Dr. Sim: Among a large diverse population of treated hypertensive people, those who achieved systolic blood pressures (SBP) in the ranges of 130-139mm Hg had the lowest risk for death and end stage renal disease (kidney failure).  Not surprisingly, those with SBP above 139 had incrementally greater risk, but somewhat surprising was that those with SBP under 130 also had a greater risk for death and kidney failure.

Medical Research: Were any of the findings unexpected?

Dr. Sim: Given recent studies suggesting no additional benefit of aggressive blood pressure treatment and perhaps greater harm or side effects, our study further supports and validates those findings.  The strength of our study is that we examined a large racially and ethnically diverse population of about 400,000 patients under a real world environment.  Our findings also are consistent with current and past blood pressure treatment guidelines.

Medical Research: What should clinicians and patients take away from your report?

Dr. Sim: Physicians often recommend bringing a patient’s blood pressure down as low as possible. However, when treating patients with hypertension, lower blood pressure is not always better. This study demonstrates that overtreatment of high blood pressure can be dangerous to a patient’s health. We need to target an appropriate blood pressure range to better treat hypertensive patients. Importantly, physicians should treat each patient individually and provide a personalized care plan for that person.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Sim: While we have been successful at stressing the importance of reducing hypertension below the high blood pressure threshold, we also need to study and establish the low treatment blood pressure thresholds.  It’s possible that down titration or withdrawal of medications in some will lead to better outcomes and quality of life.


Sim JJ, Shi J, Kovesdy CP, Kalantar-Zadeh K, Jacobsen SJ. Impact of Achieved Blood Pressures on Mortality Risk and End-Stage Renal Disease Among a Large, Diverse Hypertension Population. J Am Coll Cardiol. 2014;64(6):588-597. doi:10.1016/j.jacc.2014.04.065.


Last Updated on August 16, 2014 by Marie Benz MD FAAD