Lower BP targets offer no health benefit for patients with CVD: Cochrane review

  • Saiz LC & al.
  • Cochrane Database Syst Rev
  • 9 Sep 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Low vs standard BP targets “probably” make little to no difference in mortality outcomes for patients with hypertension and cardiovascular disease (CVD), say these Cochrane review authors.
  • The results suggest that a lower systolic BP target offers “no net health benefit,” they say.

Why this matters

  • These authors looked at outcomes based on 135/85 mmHg BP targets vs standard targets (140-160/90-100 mmHg).
  • Controversy about the lower targets has persisted since the results of SPRINT.

Key results

  • 6 randomized controlled trials included, with a total of 9484 participants.
  • Total mortality with low vs standard targets: risk ratio, 1.06 (95% CI, 0.91-1.23; moderate-quality evidence).
  • Cardiovascular mortality: 1.03 (95% CI, 0.82-1.29; moderate-quality evidence).
  • Serious adverse event rates also did not differ, and neither did total cardiovascular events (low-quality evidence for both).
  • The results suggest more participants dropped out of studies with lower targets (risk ratio, 8.16; 95% CI, 2.06-32.28; 2 studies, n=690; very low-quality evidence).
  • The lower-target group did achieve lower BP values but also needed more drugs.

Study design

  • Updated Cochrane review, including trial data up to November 2019.
  • Funding: Navarre Health Service, Spain; European Social Fund Operational Programme; others.

Limitations

  • Some data were imputed.
  • Heterogeneity among trials.