Related Experiment Video
Updated: Jun 13, 2025
Author Spotlight: Exploring Huotan Jiedu Tongluo Decoction as an Antihypertensive Drug
Published on: May 17, 2024
Optimal Antihypertensive Systolic Blood Pressure: A Systematic Review and Meta-Analysis
Paul K Whelton1,2, Samantha O'Connell1, Katherine T Mills1
1Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W., S.O.C., K.T.M., J.H.).
Insights
Lowering systolic blood pressure (SBP) to below 130 mmHg significantly reduces cardiovascular disease (CVD) and mortality risks. An SBP target below 120 mmHg also shows benefits, though with slightly increased adverse events.
Area of Science:
- Cardiology
- Clinical Trials
- Public Health
Background:
- Systolic blood pressure (SBP) lowering is proven to reduce cardiovascular disease (CVD) and mortality.
- Optimal SBP targets for intervention remain a subject of ongoing debate and research.
Purpose of the Study:
- To evaluate the efficacy of SBP targets <130 mmHg versus ≥130 mmHg in reducing CVD and all-cause mortality.
- To conduct a secondary analysis comparing SBP targets <120 mmHg versus <140 mmHg for the same outcomes.
Main Methods:
- Meta-analysis of seven randomized controlled trials involving 72,138 participants.
- Data extraction using a standardized protocol with independent, duplicate review.
- Random-effects model to calculate pooled hazard ratios (HRs) and 95% confidence intervals (CIs).
Main Results:
- An SBP target <130 mmHg significantly reduced major CVD (HR, 0.78) and all-cause mortality (HR, 0.89) compared to ≥130 mmHg.
- An intensive SBP target <120 mmHg significantly reduced major CVD (HR, 0.82) compared to <140 mmHg, with non-significant reduction in all-cause mortality.
- Intensive SBP targets were associated with a higher incidence of adverse events, though absolute risks remained low.
Conclusions:
- Targeting SBP <130 mmHg offers significant reductions in major CVD and all-cause mortality.
- Evidence supports considering an SBP target <120 mmHg, particularly in specific patient populations, while monitoring for adverse events.
Background:
Systolic blood pressure (SBP) lowering reduces major cardiovascular disease (CVD) and all-cause mortality. However, the optimal target for SBP lowering remains controversial.
Methods:
We included trials with random allocation to an SBP <130 mm Hg treatment target and CVD as the primary outcome. Data were extracted from each study independently and in duplicate using a standardized protocol. Random-effects meta-analysis was used to obtain pooled hazard ratios (HRs) and 95% CIs for CVD and all-cause mortality comparing SBP <130 and ≥130 mm Hg treatment targets. A secondary analysis compared the same outcomes for randomization to an SBP target of <120 or <140 mm Hg.
Results:
Seven trials, including 72 138 participants, met the eligibility criteria. Compared with an SBP target of ≥130 mm Hg, an SBP target of <130 mm Hg significantly reduced major CVD (HR, 0.78 [95% CI, 0.70-0.87]) and all-cause mortality (HR, 0.89 [95% CI, 0.79-0.99]). Compared with an SBP target of <140 mm Hg, an intensive SBP target of <120 mm Hg significantly reduced major CVD (HR, 0.82 [95% CI, 0.74-0.91]), but all-cause mortality was marginally insignificant (HR, 0.85 [95% CI, 0.71-1.01]). Adverse events were significantly more likely in the intensive SBP target groups, but the absolute risks were low.
Conclusions:
This study suggests targeting an SBP <130 mm Hg significantly reduces the risks of major CVD and all-cause mortality. The findings also support an SBP target of <120 mm Hg, based on a smaller number of trials.
Registration:
URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023490693.
Related Concept Videos
01:18Disorders of the Autonomic Nervous System
Raynaud's disease, also known as Raynaud's...
01:18Hypertension and Regulation of Blood Pressure
01:30Blood Pressure
The average BP in an adult is typically around 120/80 mmHg (millimeters of mercury). In this measurement, the numerator (120) indicates the systolic pressure, which is the pressure in the arteries during the contraction of the heart's ventricles as blood is expelled. The denominator (80) represents the...
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:30Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors
01:30Antihypertensive Drugs: Angiotensin II Receptor Blockers