Blood pressure targets: Is lower better?

Wednesday 1 February 2023

Vanessa Jordan

PEARLS No.

714

Clinical question

Does reducing blood pressure to 135/85mmHg (or below) reduce mortality and morbidity more than reducing it to a standard target of 140/90mmHg?

Bottom line

The evidence identified in this review does not support lower blood pressure targets (less than 135/85mmHg) as compared with standard blood pressure targets (less than 140/90mmHg) in people with hypertension and established cardiovascular disease.

This review detected no benefits for total mortality (relative risk 1.05; 95% confidence interval 0.91–1.23) or cardiovascular mortality (RR 1.03; 95% CI 0.82–1.29) if blood pressure was reduced to a lower target.

It also found that blood pressure targets were more frequently achieved in the standard target group (2849/3724 participants, or 75%) than in the lower target group (3120/4875 participants, or 64%), and more antihypertensive drugs were needed in the lower target group (mean 2.4 drugs) than in the standard target group (mean 1.9 drugs). Studies suggested there were more withdrawals due to adverse effects in the lower target group (RR 8.16; 95% CI 2.06–32.28), although the evidence was very uncertain.

Caveat

There was limited data available for people aged 75 or older, so no definitive conclusions could be made for this age group. The evidence for total mortality and cardiovascular mortality was moderate as the confidence intervals were wide and imprecise. The certainty for other outcomes was rated from low to very low due to small sample numbers and high risk of bias. Several trials are still ongoing, which may provide important input to this topic in the near future.

Context

Hypertension is a prominent preventable cause of premature morbidity and mortality. People with hypertension and established cardiovascular disease are at particularly high risk, so reducing blood pressure to below standard targets may be beneficial. This strategy could reduce cardiovascular mortality and morbidity but could also increase adverse events. The optimal blood pressure target in people with hypertension and established cardiovascular disease remains unknown.

Cochrane Systematic Review

Saiz LC, et al. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev 2022;11:CD010315. This review contains 7 trials with a total of 9595 participants.

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