BP lowering in 130-140 mmHg range: benefits vs risk

  • Brunström M & al.
  • BMJ Open
  • 30 Sep 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • This meta-analysis of randomised controlled trials yielded no evidence of primary cardiovascular prevention benefit with systolic BP lowering in the 130-140 mmHg range.
  • These authors did find evidence of harm.
  • They also found hints of benefit for people with previous cardiovascular disease, although with some caveats.

Why this matters

  • These findings counter recommendations to target systolic BP values to 120 mmHg.

Key results

  • Antihypertensive treatment for systolic BP in this range had no effect (relative risks; 95% CIs) on: 
    • All-cause mortality: 1.00 (0.95-1.06).
    • Major cardiovascular events: 1.01 (0.96-1.06).
      • But there was an increased risk of discontinuations from treatment for adverse events: 1.23 (1.03-1.47).
  • Risks were also increased specifically for hypotension-related events: 1.71 (1.32-2.22).
  • In contrast, in patients with existing cardiovascular disease, with treatment in this BP range, risk was somewhat reduced for:
    • All-cause mortality: 0.91 (0.83-0.99).
    • Major cardiovascular events: 0.85 (0.77-0.94).
      • Still, adverse events leading to discontinuation were doubled: 2.05 (1.62-2.61).

Study design

  • Systematic review, meta-analysis of 18 trials that included 92,567 people.
  • Funding: Heart Foundation of Northern Sweden; others.

Limitations

  • No patient-level data were used.