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In adults with hypertension and high CV risk, intensive vs. standard BP-lowering therapy reduced major vascular
1Charles R. Drew University & David Geffen School of Medicine at UCLA, Los Angeles, California, USA (M.B.D.).
Annals of Internal Medicine
|September 30, 2024
Insights
Intensive blood pressure lowering to below 120 mm Hg significantly reduced cardiovascular events in high-risk patients. This intensive systolic blood pressure management proved beneficial for individuals with and without diabetes or prior stroke.
Area of Science:
- Cardiovascular Medicine
- Clinical Trials
- Hypertension Management
Background:
- High cardiovascular risk necessitates effective blood pressure management strategies.
- Previous guidelines suggested different systolic blood pressure targets, creating uncertainty for high-risk populations.
- The optimal systolic blood pressure threshold for preventing major adverse cardiovascular events (MACE) remains a critical clinical question.
Purpose of the Study:
- To compare the efficacy of intensive systolic blood pressure lowering (target <120 mm Hg) versus standard lowering (target <140 mm Hg) in patients at high risk for cardiovascular events.
- To evaluate the benefit of intensive blood pressure management in subgroups, including those with diabetes or a history of stroke.
Main Methods:
- An open-label, randomized controlled trial involving patients with high cardiovascular risk.
- Blinded assessment of outcomes to minimize bias.
- Randomization to either an intensive systolic blood pressure target (<120 mm Hg) or a standard target (<140 mm Hg).
Main Results:
- The intensive blood pressure lowering strategy significantly reduced the incidence of major cardiovascular events compared to the standard strategy.
- Benefits were observed across various subgroups, including patients with diabetes and those with a previous stroke.
- No significant increase in serious adverse events was noted in the intensive treatment group.
Conclusions:
- Lowering systolic blood pressure to less than 120 mm Hg is superior to lowering it to less than 140 mm Hg for preventing cardiovascular events in high-risk individuals.
- This intensive blood pressure management strategy is safe and effective for patients with high cardiovascular risk, irrespective of diabetes or prior stroke status.
- The findings support more aggressive blood pressure targets in selected high-risk populations to improve cardiovascular outcomes.
Abstract
Source Citation:
Liu J, Li Y, Ge J, et al; ESPRIT Collaborative Group. Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial. Lancet. 2024;404:245-255. 38945140.
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