120/80 is a constructed zero, not a sourced ACM curve
This one has trial evidence — mostly in treated, higher-risk people. Brunström & Carlberg 2018 found treating an already-normal primary-prevention cuff below 140 left all-cause mortality neutral.
A joint cuff reading. The overlay is vascular death, not all-cause. Treatment trials exist — and they do not say that fine-tuning an already-normal cuff keeps buying death benefit.
Time
Validated home cuff, repeat readings
- Level
- Any
- Impact
- Low (the measurement)
- Equipment
- Upper-arm cuff
Dose
120/80 = HR 1.0. Below both readings the curve is flat at 1.0 — no reward, changed 2026-09-10 per Wang et al. 2026 (UK Biobank: usual SBP <114 carried HR 1.16 versus 120–126, not a benefit). When either is high, it takes the worse penalty: +8% per 10 mmHg SBP or per 5 mmHg DBP. No paper specifies that high-side combination. Confidence LOW.
The 120/80 zero is constructed. Below it the curve is flat (no reward, changed 2026-09-10 per Wang et al. 2026). Above it, the max-penalty rule between systolic and diastolic is a judgment call — no cited paper specifies that combination. Confidence LOW.
Dose-response shape: monotone
How to get there
The behavioural half is the practice, and it is not a referral: the habits on our habit map with blood-pressure trials behind them — DASH-style eating, less salt, regular cardio — lowered blood pressure in trials, measured in mmHg, not deaths. The other half — starting, stopping, or titrating blood-pressure medicine — belongs to a clinician, not this page.
Validated home cuff, repeat readings — seated, rested, correct cuff size. Measurement technique changes the number more than most interventions do.
Brunström: treating an already-normal primary-prevention cuff lower did not move all-cause mortality.
Evidence, by endpoint
| Endpoint | Grade | Citation |
|---|---|---|
| Vascular mortality per 20/10 mmHg usual BP | B | Lewington et al. 2002, The Lancet Supporting source (page meta, not the joint rule). IPD of 1 million adults, 61 prospective studies, no prior vascular disease. Ages 40–69, each 20 mmHg usual SBP (≈10 mmHg usual DBP) is associated with more than a twofold difference in stroke death and twofold differences in IHD and other vascular death. No threshold down to 115/75. Interpretation says “vascular (and overall) mortality”; abstract does not report an ACM relative-risk table. High-side 1.08 per 10 mmHg SBP is not Lewington’s ~2.0 per 20. |
| All-cause mortality, usual SBP <114 vs 120–126 | B | Wang et al. 2026, Journal of Hypertension UK Biobank, 80,730 adults screened free of traditional cardiovascular risk factors, 13.7-year median follow-up, 2,553 deaths, restricted cubic splines. Lowest SBP quintile (<114 mmHg) carried ACM HR 1.16 (1.02–1.32) versus the 120–126 quintile — the opposite sign from the curve’s old low-end reward. Basis for flattening the low end 2026-09-10. |
| All-cause mortality, treated achieved SBP | A | Bundy et al. 2017, JAMA Cardiology 42 trials, 144,220 treated hypertensives. Lowest ACM at mean achieved 120–124 mmHg. ACM HR vs 130–134: 0.73 (0.58–0.93); vs 140–144: 0.59 (0.45–0.77); vs ≥160: 0.47 (0.32–0.67). Treatment achieved SBP, not usual-BP observational. |
| All-cause mortality from treating below baseline 140 (primary prevention) | A | Brunström & Carlberg 2018, JAMA Internal Medicine 74 trials, 306,273 people. Primary-prevention ACM: baseline SBP ≥160 RR 0.93 (0.87–1.00); 140–159 RR 0.87 (0.75–1.00); below 140 RR 0.98 (0.90–1.06) — neutral. Bundy’s 0.73 and Ettehad’s 0.87 do not show that treating below 140 lowers ACM. |
| All-cause mortality per 10 mmHg treated SBP reduction | A | Ettehad et al. 2016, The Lancet 123 RCTs, 613,815 people. Every 10 mmHg SBP reduction: ACM RR 0.87 (0.84–0.91), I² 35%. A treatment slope, not an observational usual-BP slope. |
| All-cause mortality, intensive vs standard SBP target | A | SPRINT Research Group (Wright et al.) 2015, New England Journal of Medicine Randomized trial. 9,361 high-risk adults without diabetes; SBP target <120 vs <140. Median 3.26 y, stopped early. ACM HR 0.73 (0.60–0.90). |
| All-cause mortality after intensive control lapsed | A | Jaeger et al. 2022, JAMA Cardiology Follow-up of the randomized SPRINT trial. Intervention-period ACM HR 0.83 (0.68–1.01); at median 8.8 y total follow-up, after intensity lapsed, ACM HR 1.08 (0.94–1.23). Outpatient SBP in the intensive arm rose 132.8 → 140.4 mmHg by year 10. |
| All-cause mortality per 5 mmHg treated SBP (IPD) | A | Blood Pressure Lowering Treatment Trialists’ Collaboration (Rahimi et al.) 2021, The Lancet 48 trials, 344,716 people. Per 5 mmHg SBP: MACE HR 0.90 (0.88–0.92); ACM 0.98 (0.96–1.01); CV death 0.95 (0.92–0.99). Treatment lowers cardiovascular events far more reliably than all-cause death. |
What the dose is
One hundred twenty over eighty. That zero is constructed: HR 1.0 at 120/80. Below both numbers, the curve is flat at 1.0 — no reward, changed 2026-09-10 because Wang et al. 2026 (UK Biobank) found usual SBP under 114 carries higher, not lower, all-cause mortality (HR 1.16 versus 120–126). Above either number, it takes the worse penalty — +8% per 10 mmHg systolic or per 5 mmHg diastolic. No cited source specifies that high-side combination.
What the evidence shows
Lewington et al. 2002 (The Lancet) is the overlay: usual BP versus vascular death, no threshold down to 115/75, grade B for that endpoint. All-cause mortality from treating high blood pressure is grade A and a different design: Ettehad et al. 2016 RR 0.87 per 10 mmHg treated SBP; Bundy et al. 2017 ACM HR 0.73 at achieved 120–124 vs 130–134; SPRINT (Wright et al. 2015) ACM HR 0.73 for <120 vs <140 in high-risk adults without diabetes.
What the number is not
It is not Lewington’s twofold vascular death per 20/10 mmHg pasted onto this slider. It is not proof that pushing an already-normal cuff lower keeps buying all-cause benefit — Brunström & Carlberg 2018 found primary-prevention ACM neutral below baseline 140. It is not a durable one-time treatment effect: Jaeger et al. 2022 watched SPRINT’s intensive-arm ACM advantage disappear after intensity lapsed.
What treatment actually moves
Rahimi et al. 2021 (48-trial IPD): per 5 mmHg treated SBP, MACE HR 0.90 and all-cause mortality 0.98. Cardiovascular events move more reliably than death. That is why this page can grade treatment ACM as A and still refuse to treat 120/80 as a sourced all-cause target.
What argues against this
Brunström & Carlberg 2018 is the strongest opposing source on the target itself: in primary prevention, treating below a baseline of 140 left all-cause mortality statistically neutral (RR 0.98, 0.90–1.06). Bundy’s 0.73 and SPRINT’s 0.73 are treated, high-risk, achieved-SBP contrasts — not this cuff, and Jaeger et al. 2022 found SPRINT’s ACM gain gone once intensity lapsed (8.8 y HR 1.08). Rahimi et al. 2021: per 5 mmHg treated SBP, MACE 0.90 and ACM 0.98. Lewington is vascular death, not an ACM table. No matching usual office/home BP → ACM continuous general-population meta-analysis is available. The high-side max-penalty rule is a judgment call with confidence LOW.
Gotchas
- Lewington’s ~2.0 per 20 mmHg is vascular death, ages 40–69, down to 115/75. The curve prints 1.08 per 10 mmHg SBP on the high side.
- Bundy 0.73 is treated achieved 120–124 vs 130–134, not a home cuff sitting at 120/80.
- SPRINT excluded diabetes and was stopped early. Jaeger is the same trial after the intensive arm’s outpatient SBP drifted back toward 140.
- Rahimi’s headline context is MACE, not ACM. ACM barely moved (0.98 per 5 mmHg).
- Rapsomaniki et al. 2014 is CVD incidence, not ACM, and found no low-SBP J-shape — but Wang et al. 2026 reports the opposite for all-cause mortality itself (usual SBP <114 vs 120–126: HR 1.16). The all-cause paper is why the curve’s low end is now flat, not a reward.
Safety
- This is a cuff target on a scoring model, not a licence to start, stop, or titrate blood-pressure medicine. Work that with a clinician. Treating an already-normal reading is the Brunström gap.
Educational content only — not medical advice, diagnosis, or treatment. Not a medical device; not FDA evaluated. Consult a qualified healthcare professional about your own health, and call emergency services for urgent symptoms. Full medical disclaimer →