Blood pressure targets for people with hypertension and cardiovascular disease

Total and cardiovascular mortality appear no to be different between treating to a lower (≤ 135/85 mmHg) or to a standard blood pressure target in people with hypertension and established cardiovascular disease.

The quality of evidence is downgraded by imprecise results (few outcome events and wide confidence intervals).

Summary

A Cochrane review included 6 studies with a total of 9 795 subjects. The aim of the review was to determine if lower blood pressure (BP) targets (≤ 135/85 mmHg) are associated with reduction in mortality and morbidity as compared with standard BP targets (≤ 140 to 160/ 90 to 100 mmHg) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease). Mean follow-up was 3.7 years. BP targets were more frequently achieved in the standard BP target arm (74%) than the lower target arm (66%). More antihypertensive drugs were used in the lower BP target group (average 2.4 drugs) than in the standard arm (average 1.9 drugs). Blood pressures were lower in the lower target group by 9.5 mmHg/4.9 mmHg.

No change in total mortality or cardiovascular mortality was found (table ). A slight decrease was found with regard to fatal and non-fatal cardiovascular events (including myocardial infarction, stroke, sudden death, hospitalization or death from congestive heart failure) in favour of lower BP target, with no difference in total serious adverse events. More participant withdrew due to adverse effects in the lower target arm.

Clinical comments

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Ədəbiyyat

1. Saiz LC, Gorricho J, Garjón J et al. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev 2017;(10):CD010315.