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Treatment blood pressure targets for hypertension

Jose Agustin Arguedas1, Marco I Perez, James M Wright

  • 1Depto de Farmacologia Clinica, Facultad de Medicina, Universidad de Costa Rica, San Pedro de Montes de Oca, Costa Rica.

The Cochrane Database of Systematic Reviews
|July 10, 2009
PubMed

Insights

Lowering blood pressure targets below standard levels does not reduce mortality or morbidity. This study found no significant benefits in major cardiovascular events or mortality when aiming for lower blood pressure (BP) goals.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Clinical Trials

Background:

  • Standard clinical practice for hypertension involves blood pressure (BP) targets of ≤ 140-160/90-100 mmHg.
  • Recent guidelines suggest lower BP targets, but their impact on mortality and morbidity is unclear.

Purpose of the Study:

  • To evaluate if lower BP targets (≤ 135/85 mmHg) reduce mortality and morbidity compared to standard targets (≤ 140-160/90-100 mmHg).

Main Methods:

  • Systematic electronic search of MEDLINE, EMBASE, and CENTRAL databases.
  • Inclusion of randomized controlled trials comparing lower versus standard BP targets.
  • Primary outcomes included total mortality, cardiovascular events, myocardial infarction, stroke, heart failure, and end-stage renal disease.

Main Results:

  • Seven trials (22,089 subjects) compared diastolic BP targets; no trials compared systolic BP targets.
  • Lowering BP targets did not significantly reduce total mortality, myocardial infarction, stroke, heart failure, major cardiovascular events, or end-stage renal disease.
  • Sensitivity analyses in diabetic and renal disease patients also showed no benefit from lower BP targets.

Conclusions:

  • Treating patients to lower than standard BP targets does not decrease mortality or morbidity.
  • Further systematic reviews are underway for specific patient groups, including those with diabetes mellitus and chronic renal disease.
Abstract

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