Optimal Antihypertensive Systolic Blood Pressure: A Systematic Review and Meta-Analysis

被引:6
作者
Whelton, Paul K. [1 ,2 ]
O'Connell, Samantha [1 ]
Mills, Katherine T. [1 ]
He, Jiang [1 ,2 ]
机构
[1] Tulane Univ, Sch Publ Hlth & Trop Med, Dept Epidemiol, Room 2015,1440 Canal St, New Orleans, LA 70112 USA
[2] Tulane Univ, Sch Med, Dept Med, New Orleans, LA USA
关键词
blood pressure; cardiovascular diseases; hypertension; meta-analysis as topic; random allocation; CORONARY-ARTERY-DISEASE; HYPERTENSION CONTROL; ADULTS; IMPLEMENTATION; MANAGEMENT; DIAGNOSIS; EVENTS; RISK;
D O I
10.1161/HYPERTENSIONAHA.124.23597
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
BACKGROUND: Systolic blood pressure (SBP) lowering reduces major cardiovascular disease (CVD) and all-cause mortality. However, the optimal target for SBP lowering remains controversial. METHODS: We included trials with random allocation to an SBP <130 mm Hg treatment target and CVD as the primary outcome. Data were extracted from each study independently and in duplicate using a standardized protocol. Random-effects meta-analysis was used to obtain pooled hazard ratios (HRs) and 95% CIs for CVD and all-cause mortality comparing SBP <130 and >= 130 mm Hg treatment targets. A secondary analysis compared the same outcomes for randomization to an SBP target of <120 or <140 mm Hg. RESULTS: Seven trials, including 72 138 participants, met the eligibility criteria. Compared with an SBP target of >= 130 mm Hg, an SBP target of <130 mm Hg significantly reduced major CVD (HR, 0.78 [95% CI, 0.70-0.87]) and all-cause mortality (HR, 0.89 [95% CI, 0.79-0.99]). Compared with an SBP target of <140 mm Hg, an intensive SBP target of <120 mm Hg significantly reduced major CVD (HR, 0.82 [95% CI, 0.74-0.91]), but all-cause mortality was marginally insignificant (HR, 0.85 [95% CI, 0.71-1.01]). Adverse events were significantly more likely in the intensive SBP target groups, but the absolute risks were low. CONCLUSIONS: This study suggests targeting an SBP <130 mm Hg significantly reduces the risks of major CVD and all-cause mortality. The findings also support an SBP target of <120 mm Hg, based on a smaller number of trials.
引用
收藏
页码:2329 / 2339
页数:11
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