Optimal blood pressure target in patients with uncomplicated hypertension:   a target trial emulation study

Ran Zhang; Ivan Chun Hang Lam; Louise Emilsson; Feng Sun; Siyan Zhan; Kai Hang Yiu; Daniel Yee Tak Fong; Esther Yee Tak Yu; Celine Sze Ling Chui; Esther Wai Yin Chan; Ian Chi Kei Wong; Cindy Lo Kuen Lam; Goodarz Danaei; Eric Yuk Fai Wan

doi:10.1038/s41467-026-74041-9

Optimal blood pressure target in patients with uncomplicated hypertension: a target trial emulation study

Ran Zhang
, Ivan Chun Hang Lam
, Louise Emilsson
, Feng Sun
, Siyan Zhan
, Kai Hang Yiu
, Daniel Yee Tak Fong
, Esther Yee Tak Yu
, Celine Sze Ling Chui
, Esther Wai Yin Chan
, Ian Chi Kei Wong
, Cindy Lo Kuen Lam
, Goodarz Danaei
, Eric Yuk Fai Wan

The Chinese University of Hong Kong
University of Oxford
University of Oslo
Peking University
Department of Family Medicine, the University of Hong Kong Shenzhen Hospital, The University of Hong Kong, Hong Kong SAR, China.
Harvard T.H. Chan School of Public Health

Research output: Contribution to journal › Article › peer-review

Abstract

The limited real-world evidence on the clinical benefits of intensive blood pressure (BP) management demonstrated in randomised controlled trials has led to its poor adoption in primary care settings. Here we conducted a target trial emulation study on 118,271 patients with uncomplicated hypertension to evaluate the effectiveness and safety managed by intensive (below 130/80 mmHg) compared to standard (130-140/80-90 mmHg) BP targets using a territory-wide public healthcare database in Hong Kong. Patients in the intensive blood pressure target group were observed to incur a lower risk of hypertension related complications and all-cause mortality with no significant increased risk of the serious adverse events reported. The findings of this study provide evidence on the clinical benefits of an intensive BP management in real-world settings, supporting the adoption of a BP target of less than 130/80 mmHg in clinical guidelines for the treatment of adult patients with hypertension in primary care. [Abstract copyright: © 2026. The Author(s).]

Original language	English
Journal	Nature Communications
Early online date	5 Jun 2026
DOIs	https://doi.org/10.1038/s41467-026-74041-9
Publication status	E-pub ahead of print - 5 Jun 2026

Bibliographical note

© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Funding

This study was supported by Health Bureau [No. 18192571; E.Y.F.W.], the Government of Hong Kong Special Administrative Region, China.

Access to Document

10.1038/s41467-026-74041-9

Optimal blood pressure target in patients with uncomplicated hypertension
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing,adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source,provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are includedin the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's CreativeCommons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permissiondirectly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/
Final published version, 1.3 MBLicence: CC BY 4.0

Cite this

Zhang, R., Lam, I. C. H., Emilsson, L., Sun, F., Zhan, S., Yiu, K. H., Fong, D. Y. T., Yu, E. Y. T., Chui, C. S. L., Chan, E. W. Y., Wong, I. C. K., Lam, C. L. K., Danaei, G., & Wan, E. Y. F. (2026). Optimal blood pressure target in patients with uncomplicated hypertension: a target trial emulation study. Nature Communications. Advance online publication. https://doi.org/10.1038/s41467-026-74041-9

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