- 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.
- 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).
- Systematic review, meta-analysis of 18 trials that included 92,567 people.
- Funding: Heart Foundation of Northern Sweden; others.
- No patient-level data were used.