The STEP Trial and the Importance of Early Intensive Blood Pressure Control | JACC Deep Dive

Dr. Harlan Krumholz reviews the STEP trial, which studied over 8,500 older adults in China to compare intensive versus standard blood pressure control. The trial found that lowering systolic blood pressure to 110–130 mm Hg significantly reduced major cardiovascular events by 26% without added safety risks, confirming benefits previously shown in the SPRINT trial. A six-year follow-up revealed a lasting "legacy effect," showing that starting intensive treatment earlier produced enduring cardiovascular protection even after pressures equalized. The key takeaway: early, sustained, and carefully monitored intensive control is safe, effective, and time-sensitive—each year of delay means missed opportunities to prevent heart attacks and strokes.