Benefits and potential risks of intensive goals in the treatment of arterial hypertension - Systematic review and meta-analysis of clinical trials

Introduction and objectives: There is controversy regarding the most appropriate goals for blood pressure (BP) control. We assess the benefits and risks of choosing different therapeutic thresholds. Methods: We perform a systematic review and meta-analysis of large clinical trials to assess the impact of different therapeutic strategies on the reduction of cardiovascular events and the development of serious adverse effects. Results: Four trials with 29,820 participants were included, with mean age of 65 +/- 7.9 years; 42.2% were women and 22% were diabetic. Overall, intensive goals showed a non-significant trend toward reducing cardiovascular mortality (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.68-1.07; p = 0.16) with non-impact in total mortality (p = 0.45) and with moderate heterogeneity among the included trials (I index [I] 2:44 and 59%, respectively). Nevertheless, intensive goals reduce non-fatal cardiovascular events (RR: 0.82; 95% CI: 0.70-0.91; p = 0.0003), being consistent in all the analyzed trials (I2: 0%). Regarding adverse effects, intensive goals caused more emergency consultations or hospitalization (RR: 1.98; 95% CI: 1.59-2.46; p < 0.0001; I2: 14%), with no clear increase in renal failure (RR: 1.65; 95% CI: 0.94-2.89) but with increase in falls and syncope (RR: 2.39; 95% CI: 1.56-3.67; p < 0.0001; I2: 28%). Conclusion: Intensive BP goals reduce non-fatal cardiovascular events, without reduction in mortality, and with an increase of risk of adverse events. These results suggest that individual goals should be set according to the risk of each patient. Clinical trial registration: PROSPERO (CRD42020149134).