Association Between Follow-Up Mean Blood Pressure and Blood Pressure Control: A Meta-Regression Analysis of 101...

The relationship between mean blood pressure (BP) and BP control remains uncertain, particularly the mean BP required to achieve BP control (<140/90 mm Hg) in most patients. This review assesses the association between mean BP and BP control using data from randomized clinical trials (RCTs).

Electronic literature databases were searched to identify individual RCTs (iRCTs) and cluster RCTs (cRCTs) that randomized adults to BP-lowering interventions and reported both mean BP at final follow-up visit (mean BP) and the proportion of participants achieving BP control at the final follow-up visit (BP control).

A linear regression model was used to evaluate the association between mean BP and BP control. A total of 101 RCTs (65 iRCTs [57 201 participants] and 36 cRCTs [28 154 participants]) were included. Overall, mean systolic BP (SBP) of 120, 125, 130, and 135 mm Hg corresponded to BP control in 85%, 75%, 65% and 55% of the participants in iRCTs and 87%, 77%, 67%, 57% in cRCTs. Each 1 mm Hg reduction in mean SBP was associated with approximately a 2% increase in BP control (Pseudo-R²=78% for iRCTs; 76% for cRCTs). This association was consistent across BP-lowering drug classes, baseline SBP categories, and pretrial treatment status in iRCTs, and across country income levels and baseline SBP categories in cRCTs. A similar association was seen for DBP.

An SBP below 125 mm Hg was associated with achieving BP control in ≈80% of patients. These findings can inform guideline recommendations, guide clinical management and shape hypertension control programs.