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Should you aim to lower blood pressure below 135/85mmHg in those with hypertension and a history of cardiovascular disease?
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Should you aim to lower blood pressure below 135/85mmHg in those with hypertension and a history of cardiovascular disease?
Are lower blood pressure targets (≤135/85mmHg) associated with a greater reduction in mortality and morbidity than standard blood pressure targets (≤140–160/90–100mmHg) in the treatment of people with hypertension and a history of cardiovascular disease?
The evidence identified in this review does not support lower blood pressure targets (≤135/85mmHg) over standard blood pressure targets (≤140–160/90–100mmHg) in people with hypertension and established cardiovascular disease (myocardial infarction, stroke, chronic peripheral vascular occlusive disease or angina pectoris). Predefined subgroup analyses in older people, in people with diabetes, or based on participant’s sex did not suggest any differences in these conclusions.
In order to reach the lower blood pressure target, more medication was required, with those in the lower target group requiring more antihypertensive drugs than those in the standard care group (mean difference 0.56; 95% confidence interval 0.16–0.96). Most withdrawals due to adverse effects occurred in the lower target group (risk ratio 8.16; 95% CI 2.06–32.28). However, little evidence was available for this outcome, making establishment of a trustworthy global assessment of benefits and harms very challenging.
Some uncertainties remain as the evidence was very low quality for withdrawals due to adverse effects.
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.
Saiz LC, et al. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev 2020, Issue 9. Art. No.: CD010315. DOI: 10.1002/14651858.CD010315.pub4. This review contains 6 trials with a total of 9484 participants.