Study Questions Recommended Blood Pressure Targets
Findings from a recent meta-analysis and systematic review support the significant reduction of systolic blood pressure (SBP) below recommended targets in adults with hypertension. The analysis suggested that lowering SBP by 10 mm Hg, from 130 to 134 mm Hg to 120 to 124 mm Hg, could reduce the risk of cardiovascular disease by 29%.
The review included 42 clinical trials that randomly allocated antihypertensive medication, control, or treatment targets to a total of 144,200 patients. Cardiovascular disease and all-cause mortality were assessed as the primary outcomes.
Overall, the researchers found a linear association between mean achieved SBP and risk of cardiovascular disease and mortality, with the lowest risk found in participants with a mean SBP of 120 to 124 mm Hg.
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The participants who achieved a mean SBP of 120 to 124 mm Hg had a hazard ratio (HR) of 0.71 for major cardiovascular disease compared with participants who achieved a mean SBP of 130 to 134 mm Hg. Additionally, participants who achieved a mean SBP of 120 to 124 mm Hg had HRs of 0.58, 0.46, and 0.36 for major cardiovascular disease when compared to participants who achieved a mean SBP of 140 to 144 mm Hg, 150 to 154 mm Hg, and 160 mm Hg or more, respectively.
Similarly, the HRs for all-cause mortality showed a similar pattern between SBP and risk of death. Those who achieved a mean SBP of 120 to 124 mm Hg had an HR for all-cause mortality of 0.73, 0.59, 0.51, and 0.47 compared with participants who achieved a mean SBP of 130 to 134 mm Hg, 140 to 144 mm Hg, 150 to 154 mm Hg, and 160 mm Hg or more, respectively.
“Our study indicates that treating patients to reduce SBP below currently recommended targets may significantly reduce risk of CVD and all-cause mortality,” the researchers concluded. “These findings support more intensive SBP control among adults with hypertension and suggest the need for revising the current clinical guidelines for management of hypertension.”
—Melissa Weiss
Reference:
Bundy JD, Li C, Stuchlik P, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis [published online May 31, 2017]. JAMA Cardiol. doi:10.1001/jamacardio.2017.1421.