Tip · Tracking
Blood pressure target – the 120 at home is a different one
The target below 120 mmHg comes from SPRINT: 9,361 people at increased risk but without diabetes, 27 percent lower all-cause mortality. Measurement there followed strict rules.
Below 120: behind this number stands one of the clearest findings in cardiovascular medicine, now shown in three large randomised trials. It was, however, measured in a particular way. This page shows how well the target is supported and why the value on your home monitor is not automatically the same number.
In short
In 2015, SPRINT randomised 9,361 people with increased cardiovascular risk but without diabetes to an upper blood pressure value below 120 versus below 140 millimetres of mercury. The stricter target reduced major cardiovascular events with a hazard ratio of 0.75 and all-cause mortality by 27 percent; the trial was stopped early after a median of 3.26 years. Two large trials from China have since confirmed the benefit, one of them in type 2 diabetes. The limits lie in the cost and in the transfer: low pressure, fainting and acute kidney injury occurred more often, and measurement followed a strict protocol, not the way it is done at the kitchen table.
What the target means and how it was measured
It refers to the upper, systolic value. SPRINT, a publicly funded US trial, tested a target below 120 against the then usual target below 140 in people with a baseline value of 130 or more and increased cardiovascular risk. After one year, the mean was 121.4 versus 136.2.
Decisive for the transfer is the measurement. In SPRINT, an automated upper-arm device measured three times after 5 minutes of rest, averaged, with a cuff chosen by arm circumference. Whether participants were alone in the room was not prescribed and differed between sites; it played no recognisable role for the benefit.
What is well supported
The target itself is well tested: three large randomised trials, each time with benefit. After SPRINT, ESPRIT in 2024 with 11,255 participants in China arrived at a hazard ratio of 0.88, with no difference between people with and without diabetes or previous stroke. BPROAD in 2025 with 12,821 people with type 2 diabetes arrived at 0.79. In addition, the SPRINT substudy on memory showed almost a fifth fewer cases of mild cognitive impairment.
What the studies show
SPRINT, New England Journal of Medicine 2015
9,361 people with increased cardiovascular risk but without diabetes, target below 120 versus below 140. The primary endpoint of myocardial infarction, other acute coronary syndromes, stroke, heart failure and cardiovascular death was 1.65 versus 2.19 percent per year, hazard ratio 0.75; all-cause mortality was 27 percent lower at 0.73. Because of the clear benefit, the trial was stopped after a median of 3.26 years.
SPRINT MIND, JAMA 2019
The same participants, cognitive follow-up over a median of 5.11 years. Mild cognitive impairment occurred less often in the strict group, hazard ratio 0.81. For probable dementia, the result of 0.83 pointed in the same direction, but the difference was not confirmed; because of the early stop and fewer cases than expected, the trial may have been too small for this.
Measurement in SPRINT, Hypertension 2018
A survey after the end of the trial found: at 38 sites with 4,082 participants, nobody was in the room during measurement; at 25 sites with 2,247 participants, someone was present the whole time. The risk reduction from the stricter target was 0.62 and 0.64, practically the same.
ESPRIT, The Lancet 2024
11,255 participants from 116 hospitals and communities in China, including 4,359 with diabetes and 3,022 after a stroke, target below 120 versus below 140 in standard office measurement. After a median of 3.4 years, the primary endpoint occurred in 9.7 versus 11.1 percent, hazard ratio 0.88. Fainting was more frequent in the strict group, 0.4 versus 0.1 percent.
BPROAD, New England Journal of Medicine 2025
12,821 people aged 50 and over with type 2 diabetes at 145 sites in China, target below 120 versus below 140, up to 5 years of treatment. After a median of 4.2 years, the primary endpoint was 1.65 versus 2.09 events per 100 person-years, hazard ratio 0.79. Serious adverse events overall were equally frequent; symptomatic low pressure and raised potassium were more frequent.
Cuff size, JAMA Internal Medicine 2023
Randomised crossover trial with 195 adults, automated device with a fitting and an ill-fitting cuff. Someone who needs an extra-large cuff and gets the regular one measures on average 19.5 millimetres too high, with a large cuff 4.8 millimetres. Someone who needs a small cuff measures 3.6 millimetres too low with the regular one.
Where the data stop
The limit lies in the transfer. All three trials measured according to the rules, with rest, repetition and a fitting cuff; a quick office reading or a single morning value arises differently. How large the deviation is differs from person to person, and there is no conversion table. For a whole week of morning and evening values, separate thresholds apply, and your doctor interprets them.
The second limit is the target group. SPRINT excluded people with diabetes and previous stroke; ESPRIT and BPROAD have since largely closed this gap. Whom the strict target suits is not decided for you by any trial, but by your doctor.
How to do it
Measure by the same rule the trials used: sit for five minutes, back supported, arm at heart level, do not talk, take the mean of several readings. Choose the cuff according to your arm circumference; with very strong upper arms, the wrong size can make almost 20 millimetres of difference, as much as the entire gap between the two targets.
A value you take standing up between two appointments means something different from the 120 in the trial. Your doctor has to interpret it; your device counts, it just counts differently. You do not change blood pressure medication on your own.
Safety
The benefit has a price, and it is in the same abstract as the benefit. In SPRINT, serious events such as blood pressure that was too low, fainting, electrolyte disturbances and acute kidney injury occurred more often under the stricter target, but injurious falls did not. In ESPRIT, fainting was more frequent; in BPROAD, symptomatic low pressure and raised potassium. That is why the stricter target belongs in a doctor’s hands, with regular check-ups.
BK-Score Well supported, heavily overhyped
| Human evidence | 9 | |
|---|---|---|
| Mechanism | 8 | |
| Safety data | 6 | |
| Hype gap | 3 | |
| Track record of use | 9 |
SPRINT (NEJM 2015) randomised 9,361 people with increased cardiovascular risk but without diabetes to a systolic target below 120 versus below 140 mmHg. The primary endpoint was 1.65 versus 2.19 percent per year (HR 0.75), all-cause mortality 27 percent lower (HR 0.73) – the trial was stopped early after a median of 3.26 years. The safety deduction is real and is in the same abstract: hypotension, syncope, electrolyte disturbances and acute kidney injury occurred more often; injurious falls did not. Decisive for the transfer to the home is the measurement method: SPRINT measured with a specified automated upper-arm device according to protocol. The same numerical value arises differently at the kitchen table.
The score rates the state of knowledge, not the effect. “Safety data 9” means well studied – not harmless.
Subjective assessment by Biohacking Kompakt based on published scoring rules – not a scientific rating and not a medical recommendation. Rules and all ratings (German)
Frequently asked questions about the blood pressure target
Does the target below 120 apply to everyone?
Not automatically. SPRINT studied people with increased cardiovascular risk without diabetes, ESPRIT included people with diabetes and after stroke, and BPROAD people with type 2 diabetes. All three found a benefit, but also more side effects such as low pressure or fainting. Your doctor decides which target suits you.
Why does my home monitor show different values from the trial?
Because the trial measured strictly by protocol: automated upper-arm device, 5 minutes of rest, three readings, averaged, cuff chosen by arm circumference. A single value in everyday life arises differently. A cuff that is too small alone can show on average 19.5 millimetres too much with strong upper arms.
Does it matter whether someone is in the room during measurement?
For the benefit of the stricter target, apparently hardly. In SPRINT, the risk reduction was 0.62 at sites where nobody was in the room and 0.64 at sites where someone was present the whole time. ESPRIT also confirmed the target with standard office measurement.
What side effects does a stricter blood pressure target have?
In SPRINT, blood pressure that was too low, fainting, electrolyte disturbances and acute kidney injury occurred more often, but injurious falls did not. In ESPRIT, fainting was more frequent at 0.4 versus 0.1 percent; in BPROAD, symptomatic low pressure and raised potassium. That is why the target is supervised by a doctor.
Does lower blood pressure also protect memory?
Partly supported. In the SPRINT substudy, mild cognitive impairment occurred less often in the strict group, hazard ratio 0.81. For dementia, the result pointed in the same direction without a confirmed difference, partly because the trial ended early.
The podcast episode (in German)
Episode 114
The blood pressure target – why the 120 means something different at home
The podcast by Paul Höser (Episode 114) · with Paul & Paula. How SPRINT lowered mortality with the target of 120, how it was measured there – and why the 120 on a home monitor is not the same number as the one from the trial. Information only, not a usage recommendation.
Sources
- SPRINT — SPRINT Research Group, New England Journal of Medicine 2015, 9,361 participants, target below 120 versus below 140
- SPRINT MIND — SPRINT MIND Investigators, JAMA 2019, dementia and mild cognitive impairment
- Blood pressure measurement in SPRINT — Johnson et al., Hypertension 2018, with and without staff in the room
- ESPRIT — Liu et al., The Lancet 2024, 11,255 participants from 116 hospitals and communities in China
- BPROAD — Bi et al., New England Journal of Medicine 2025, 12,821 people with type 2 diabetes
- Cuff size — Ishigami et al., JAMA Internal Medicine 2023, randomised crossover trial, 195 adults
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Information only, not medical advice and not a usage recommendation. With pre-existing conditions and before major changes, consult a physician. Last updated: 2026-11-10.