JACC

Volume 86, Issue 17, 28 October 2025, Pages 1402-1404

Original Researcht
Editorial Comment
Does Intensive Blood Pressure Control Affect How Patients Feel?

https://doi.org/10.1016/j.jacc.2025年06月01日1 Get rights and content

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What the ESPRIT Study Found

The ESPRIT trial randomized 10,804 adults with hypertension and high cardiovascular risk to receive either intensive BP treatment (target systolic BP to <120 mm Hg) or standard treatment (<140 mm Hg).5 Health-related quality of life (HRQoL) was assessed at baseline and at the end of the study (a median follow-up of 3.4 years) using the 5-level EuroQol Five Dimensions Questionnaire (EQ-5D-5L) instrument. Although the authors reported both the utility index and the visual analog scale (VAS)

Implications for Clinical Care

These findings5 offer an important tool for conversations with patients who are hesitant about intensifying BP treatment. In addition to emphasizing the well-known benefits for reducing cardiovascular events, we can now reassure patients that treatment intensification is unlikely to worsen their quality of life, and may actually improve it. Notably, some of the patients we are most cautious about treating aggressively, such as older and more frail individuals, appeared to derive the greatest

Methodologic Considerations

Despite the strengths of the ESPRIT analysis, including a large sample size, diverse population, and high follow-up completeness,5 there are limitations to consider. The EQ-5D, although validated and widely used, is a relatively crude instrument and lacks sensitivity to detect subtle, disease-specific symptoms. Although no robust hypertension-specific, patient-reported outcome measures currently exist, symptoms such as fatigue, dizziness, or cognitive decline that can occur with overtreatment

A Broader Message

The ESPRIT trial’s5 inclusion of patient-reported outcomes aligns with a growing recognition that treatment decisions should be guided not only by clinical event reductions but also by how patients feel and function. The modest but favorable effects of intensive BP control on HRQoL highlight the importance of systematically incorporating patient-reported outcomes into hypertension trials and guidelines. Capturing patients’ health status, alongside clinical events of stroke, heart failure, and

Funding Support and Author Disclosures

Dr Lu received support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (under awards R01HL69954 and R01HL169171), the Patient-Centered Outcomes Research Institute (under award HM-2022C2-28354), Sentara Research Foundation, and Novartis through Yale University outside of the submitted work. Dr Spertus discloses providing consultative services on patient-reported outcomes and evidence evaluation to BioHaven, Janssen, Bristol Myers Squibb, Terumo,

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© 2025 by the American College of Cardiology Foundation. Published by Elsevier.