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Systolic blood pressure targets below 120 mm Hg are associated with reduced mortality: A meta-analysis
Felix Bergmann1, Marlene Prager1, Lena Pracher1
1Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
Insights
Intensive systolic blood pressure control (<120 mmHg) in high-risk patients reduced mortality and major adverse cardiovascular events (MACE). However, it increased risks of adverse events like hypotension and acute kidney injury.
Area of Science:
- Cardiology
- Hypertension Management
- Clinical Trials
Background:
- Optimal systolic blood pressure (SBP) targets for individuals at high cardiovascular risk are not definitively established.
- Uncertainty exists regarding the benefits and risks of intensive versus standard SBP control strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of intensive SBP control (<120 mmHg) compared to standard SBP control (<140 mmHg).
- To assess the impact on mortality, major adverse cardiovascular events (MACE), and specific safety outcomes in high-risk populations.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched major databases (PubMed, Embase, Web of Science, Cochrane Library) up to November 2024.
- Included studies comparing intensive (<120 mmHg) versus standard (<140 mmHg) SBP control in high cardiovascular risk adults.
Main Results:
- Five RCTs with 39,434 patients were analyzed.
- Intensive SBP control significantly lowered all-cause mortality (RR 0.87; P=0.03) and MACE.
- Intensive control also reduced cardiovascular death, stroke, myocardial infarction, and heart failure, but increased risks of hypotension, syncope, and acute kidney injury.
Conclusions:
- Targeting SBP <120 mmHg in high-risk patients reduces all-cause mortality and MACE.
- This intensive strategy is associated with a higher incidence of adverse events, including hypotension and electrolyte abnormalities.
- The findings suggest a trade-off between cardiovascular benefit and safety concerns with intensive SBP control.
Background:
The optimal systolic blood pressure (SBP) target in patients with increased cardiovascular risk remains uncertain. This study evaluated the efficacy and safety of intensive SBP control (<120 mm Hg) compared to standard SBP control (<140 mm Hg) in patients with increased cardiovascular risk.
Methods:
We conducted a systematic search of PubMed, Embase, Web of Science, and Cochrane Library for RCTs published from database inception through November 2024 that compared intensive SBP control (<120 mm Hg) with standard SBP control (<140 mm Hg) in adults with high cardiovascular risk. Efficacy outcomes included all-cause mortality, major adverse cardiovascular events (MACE), cardiovascular death, stroke, myocardial infarction (MI), and heart failure. Safety outcomes included hypotension, syncope, arrhythmia, acute kidney injury, and electrolyte abnormalities.
Results:
Five RCTs comprising 39,434 patients were included. The all-cause mortality was significantly lower in the intensive SBP control group (672 of 19,712 [3.4%]) compared to the standard SBP control group (778 of 19,722 [3.9%]) (risk ratio 0.87 [95% confidence interval, 0.76-0.99, p = 0.03]). The incidence of MACE, cardiovascular death, MI, stroke, and heart failure was significantly lower in the intensive SBP control group as compared to standard SBP control group. The treatment effect (MACE) was consistent across all subgroups. Conversely, intensive SBP control was associated with an increased risk of hypotension, syncope, arrhythmia, acute kidney injury, and electrolyte abnormalities.
Conclusions:
Targeting intensive SBP control to less than 120 mm Hg was associated with a lower incidence of all-cause mortality and MACE but a higher incidence of adverse events.
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