Should you aim to lower blood pressure below 135/85mmHg in those 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.