The DOI matches its Crossref record, with a small difference in title or year; 32 of the 33 references it cites were found in a registry or an index.
Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality: A Systematic Review and Network Meta-analysis
Open accessAbstract
Importance: Clinical trials have documented that lowering blood pressure reduces cardiovascular disease and premature deaths. However, the optimal target for reduction of systolic blood pressure (SBP) is uncertain. Objective: To assess the association of mean achieved SBP levels with the risk of cardiovascular disease and all-cause mortality in adults with hypertension treated with antihypertensive therapy. Data Sources: MEDLINE and EMBASE were searched from inception to December 15, 2015, supplemented by manual searches of the bibliographies of retrieved articles. Study Selection: Studies included were clinical trials with random allocation to an antihypertensive medication, control, or treatment target. Studies had to have reported a difference in mean achieved SBP of 5 mm Hg or more between comparison groups. Data Extraction and Synthesis: Data were extracted from each study independently and in duplicate by at least 2 investigators according to a standardized protocol. Network meta-analysis was used to obtain pooled randomized results comparing the association of each 5-mm Hg SBP category with clinical outcomes after adjusting for baseline risk. Main Outcomes and Measures: Cardiovascular disease and all-cause mortality. Results: Forty-two trials, including 144 220 patients, met the eligibility criteria. In general, there were linear associations between mean achieved SBP and risk of cardiovascular disease and mortality, with the lowest risk at 120 to 124 mm Hg. Randomized groups with a mean achieved SBP of 120 to 124 mm Hg had a hazard ratio (HR) for major cardiovascular disease of 0.71 (95% CI, 0.60-0.83) compared with randomized groups with a mean achieved SBP of 130 to 134 mm Hg, an HR of 0.58 (95% CI, 0.48-0.72) compared with those with a mean achieved SBP of 140 to 144 mm Hg, an HR of 0.46 (95% CI, 0.34-0.63) compared with those with a mean achieved SBP of 150 to 154 mm Hg, and an HR of 0.36 (95% CI, 0.26-0.51) compared with those with a mean achieved SBP of 160 mm Hg or more. Likewise, randomized groups with a mean achieved SBP of 120 to 124 mm Hg had an HR for all-cause mortality of 0.73 (95% CI, 0.58-0.93) compared with randomized groups with a mean achieved SBP of 130 to 134 mm Hg, an HR of 0.59 (95% CI, 0.45-0.77) compared with those with a mean achieved SBP of 140 to 144 mm Hg, an HR of 0.51 (95% CI, 0.36-0.71) compared with those with a mean achieved SBP of 150 to 154 mm Hg, and an HR of 0.47 (95% CI, 0.32-0.67) compared with those with a mean achieved SBP of 160 mm Hg or more. Conclusions and Relevance: This study suggests that reducing SBP to levels below currently recommended targets significantly reduces the risk of cardiovascular disease and all-cause mortality. These findings support more intensive control of SBP among adults with hypertension.
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“and lowering BP substantially reduces that risk.5–7”
From International Consensus on Standardized Clinic Blood Pressure Measurement – A Call to Action (2023) · cites this paper as [6]
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“This is clinically meaningful as lower SBP values have been associated with progressively reduced risks of stroke, major cardiovascular events, and cardiovascular as well as all-cause mortalities [40].”
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“The change of BP reclassification by the 2017 ACC/AHA guideline writers was also supported by a meta-analysis study [6] that showed that lowering SBP of hypertensive patients to a level of 120–124 mmHg had a lower risk for CVD events and all-cause mortality compared with lowering SBP to a level of 130–134 mmHg.”
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“21 SBP reductions of this magnitude are associated with ≈40% relative risk reduction in major cardiovascular events and all-cause mortality, 22 and DBP is also independently associated with adverse cardiovascular events, especially in younger people.”
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“These deaths are mostly preventable, as lowering the systolic blood pressure (SBP) can lessen fatalities from all causes and cardiovascular disease (CVD) [5].”
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“Meta-analyses of randomized trials of antihypertensive medication have suggested that treating SBP to <120 mm Hg is associated with reduced CVD risk.(15) For individuals with CKD, the evidence supporting the SBP target <120 mm Hg is largely derived from SPRINT, which included 2646 patients with CKD, defined as eGFR <6…”
BackgroundAbariga, S. A., Khachan, H., & Kibria, G. M. A. (2019) · American Journal of Hypertension · doi:10.1093/ajh/hpz181 · Cited by 34
Evidence for the Universal Blood Pressure Goal of <130/80 mm Hg Is Strong
Carey, R. M., & Whelton, P. K. (2020) · Hypertension · doi:10.1161/hypertensionaha.120.14647 · Cited by 32
“Thus, when scrutinized through the lens of evidence-based medicine, there remains insufficient justification for a universal BP goal of 130/80 mm Hg. Finally, I am grateful to the journal for providing the platform to engage in a spirited exchange with Drs Carey and Whelton.”
BackgroundResultInfluentialSelf-citationA global analysis of dairy consumption and incident cardiovascular disease
Zhuang, P., Liu, X., Yin, L., Ao, Y., Wu, Y., Ye, H., Wan, X., Zhang, L., Meng, D., Tian, Y., et al. (2025) · Nature Communications · doi:10.1038/s41467-024-55585-0 · Cited by 34
“Hypertension is a well-established risk factor for CVD, making those with high blood pressure more susceptible to cardiovascular damage 67 .”
Wang, T., Lee, Y., Chang, S., Tung, Y., Yeh, C., Lin, Y., Pan, C., Hsu, C., Huang, C., Wu, C., et al. (2019) · PubMed Central · doi:10.6515/acs.201905_35(3).20190415a · Cited by 31
Medication Adherence: Expanding the Conceptual Framework
Krousel-Wood, M. A., Craig, L. S., Peacock, E., Zlotnick, E., O’Connell, S. S., Bradford, D., Shi, L., & Petty, R. E. (2021) · American Journal of Hypertension · doi:10.1093/ajh/hpab046 · Cited by 34
Narita, K., Hoshide, S., & Kario, K. (2021) · Hypertension Research · doi:10.1038/s41440-021-00757-4 · Cited by 31
Asgari, S., Khaloo, P., Khalili, D., Azizi, F., & Hadaegh, F. (2019) · Scientific Reports · doi:10.1038/s41598-019-42809-3 · Cited by 30
Shen, Y. H., Dai, Y., Wang, X. Q., Zhang, R., Lu, L., Ding, F. H., & Shen, W. F. (2019) · Cardiovascular Diabetology · doi:10.1186/s12933-019-0959-1 · Cited by 32
“BP levels in diabetic patients with stable coronary artery disease The beneficial effects of anti-hypertensive drugs on clinical and cardiovascular outcomes are well established [53], and strict BP control is strongly recommended by most previous guidelines for general patients [13–15, 17].”
BackgroundPatient preferences for management of high blood pressure in the UK: a discrete choice experiment
Fletcher, B., Hinton, L., McManus, R. J., & Rivero‐Arias, O. (2019) · British Journal of General Practice · doi:10.3399/bjgp19x705101 · Cited by 33
“14 Since this study, there have been new reviews of the evidence, with similar findings: 15,16 for example, in a review and meta-analysis published in 2017, lowering systolic BP by 10 mmHg was associated with 7% reduction in all-cause mortality, 15% reduction in cardiovascular mortality, 22%”
Zhang, Y. S., Strauss, J. A., Hu, P., Zhao, Y., & Crimmins, E. M. (2021) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbab059 · Cited by 28
“, 1999; Strandberg & Tilvis, 2000), while the relationships between mortality and blood pressure, cholesterol, and triglycerides are less clear, especially at advanced ages (Bundy et al., 2017; Cooney et al., 2009; Criqui et al., 1993; Lv et al., 2015, 2018; Ravindrarajah et al., 2017; Ravnskov et al., 2016).”
BackgroundHickey, M. D., Ayieko, J., Owaraganise, A., Sim, N., Balzer, L. B., Kabami, J., Atukunda, M., Opel, F. J., Wafula, E. M., Nyabuti, M., et al. (2021) · PLoS Medicine · doi:10.1371/journal.pmed.1003803 · Cited by 29
“Despite clear evidence of the efficacy of antihypertensive treatment [7,8], our study is the first, to our knowledge, to demonstrate reductions in population-level mortality through implementation of an integrated hypertension–HIV chronic care model in SSA.”
BackgroundResultBarbato, E., Azizi, M., Schmieder, R. E., Lauder, L., Böhm, M., Brouwers, S., Bruno, R. M., Dudek, D., Kahan, T., Kandzari, D. E., et al. (2023) · EuroIntervention · doi:10.4244/eij-d-22-00723 · Cited by 29
Martín‐Fernández, J., Alonso‐Safont, T., Polentinos-Castro, E., Esteban-Vasallo, M. D., Ariza-Cardiel, G., Anglada, M. I. G., Perruca, L. S., Rodríguez-Martínez, G., del Campo, R. R., & Bilbao‐González, A. (2023) · BMC Family Practice · doi:10.1186/s12875-023-02036-2 · Cited by 29
Expert consensus on blood pressure management in critically ill patients
Yu, Y., Gong, Y., Hu, B., Ouyang, B., Pan, A., Liu, J., Liu, F., Shang, X., Yang, X., Tu, G.-W., et al. (2023) · Journal of Intensive Medicine · doi:10.1016/j.jointm.2023.06.001 · Cited by 32
Han, J., Guo, L., Chen, X.-H., Xie, Q., Song, X.-Y., & Ma, Y.-L. (2024) · Medicine · doi:10.1097/md.0000000000036784 · Cited by 28
“[9] Long-term hypertension can result in life-threatening complications such as CVD, stroke, renal failure, and fundus lesions.”
BackgroundCost-Effectiveness and Challenges of Implementing Intensive Blood Pressure Goals and Team-Based Care
Derington, C. G., King, J. B., Bryant, K. B., McGee, B. T., Moran, A. E., Weintraub, W. S., Bellows, B. K., & Bress, A. P. (2019) · Current Hypertension Reports · doi:10.1007/s11906-019-0996-x · Cited by 30
Sun, Y., Li, Z., Guo, X., Zhou, Y., Ouyang, N., Xing, L., Sun, G., Mu, J., Wang, D. W., Zhao, C., et al. (2021) · American Journal of Hypertension · doi:10.1093/ajh/hpab038 · Cited by 28
Self-citationStamm, P., Oelze, M. W., Steven, S., Kröller‐Schön, S., Kvandová, M., Kalinovic, S., Jasztal, A., Kij, A., Kuntić, M., Jiménez, M. T. B., et al. (2021) · Nitric Oxide · doi:10.1016/j.niox.2021.06.001 · Cited by 29
Gondi, S., Ellis, S. D., Gupta, M., Ellerbeck, E. F., Richter, K. P., Burns, J. M., & Gupta, A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0255578 · Cited by 29
Henney, A. E., Gillespie, C. S., Alam, U., Hydes, T., Boyland, E. J., & Cuthbertson, D. J. (2024) · Obesity Reviews · doi:10.1111/obr.13682 · Cited by 34
Desai, T., Roberts, M. G., & Bottoms, L. (2019) · Journal of Functional Foods · doi:10.1016/j.jff.2019.04.005 · Cited by 27
“Bundy et al. (2017) reported that a reduction in bSBP of greater than 5 mmHg was clinically relevant and associated with lower CVD/mortality risk.”
Bann, D., Fluharty, M., Hardy, R., & Scholes, S. (2020) · BMC Medicine · doi:10.1186/s12916-020-01800-w · Cited by 29
Lindman, B., Goel, K., Bermejo, J., Beckman, J., O'leary, J., Barker, C., Kaiser, C., Cavalcante, J., Elmariah, S., Huang, J., et al. (2019) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.119.014020 · Cited by 23
“Other large meta-analyses recommend a target SBP <130 mm Hg as well.(4,5) The SPRINT (Systolic Blood Pressure Intervention Trial) showed that targeting an SBP <120 mm Hg yields better clinical outcomes than a target of <140 mm Hg, a finding which was also observed in patients aged >75 years regardless of their relativ…”
BackgroundHuang, L., Tian, M., Yu, J., Li, Q., Liu, Y., Yin, X., Wu, J. H. Y., Marklund, M., Wu, Y., Li, N., et al. (2020) · American Heart Journal · doi:10.1016/j.ahj.2019.12.020 · Cited by 27
Gan, L., Zhao, B., Inoue‐Choi, M., Liao, L. M., Graubard, B. I., Weinstein, S. J., Albanes, D., & Huang, J. (2024) · BMC Medicine · doi:10.1186/s12916-024-03350-x · Cited by 26
Vaquero, M., Molina‐Luque, R., del Pozo, F. J. F., Molina‐Recio, G., López‐Miranda, J., & Romero‐Saldaña, M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17124415 · Cited by 26
Li, C., Chen, K., Cornelius, V. R., Tomeny, E., Wang, Y., Yang, X., Yuan, X., Qin, R., Yu, D., Wu, Z., et al. (2021) · PLoS Medicine · doi:10.1371/journal.pmed.1003515 · Cited by 26
“This significant finding was supported by 2 meta-analyses of randomized clinical trials [9,10] and had far-reaching implications for hypertension guidelines across the world [11,12].”
ResultSelf-citationSPRINT Revisited: Updated Results and Implications
Wright, J. T., Whelton, P. K., Johnson, K., Snyder, J. K., Reboussin, D. M., Cushman, W. C., Williamson, J. D., Pajewski, N. M., Cheung, A. K., Lewis, C. E., et al. (2021) · Hypertension · doi:10.1161/hypertensionaha.121.17682 · Cited by 28
Self-citationExercise to Treat Hypertension: Late Breaking News on Exercise Prescriptions That FITT
Alves, A. J., Wu, Y., Lopes, S., Ribeiro, F., & Pescatello, L. S. (2022) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000983 · Cited by 28
Xu, X., Islam, S. M. S., Schlaich, M. P., Jennings, G., & Schutte, A. E. (2024) · PLoS ONE · doi:10.1371/journal.pone.0297229 · Cited by 26
Naser, A. M., He, F. J., Rahman, M. M., & Campbell, N. R. C. (2021) · Hypertension · doi:10.1161/hypertensionaha.120.16651 · Cited by 26
Tian, J., Sheng, C., Sun, W., Song, X., Wang, H., Li, Q., Li, W., & Wang, W. (2018) · Diabetes Care · doi:10.2337/dc18-0918 · Cited by 25
Kebede, B., Chelkeba, L., & Dessie, B. (2021) · SAGE Open Medicine · doi:10.1177/20503121211006000 · Cited by 22
Improving hypertension control and cardiovascular health: An urgent call to action for nursing
Hannan, J. A., Commodore-Mensah, Y. Y., Tokieda, N., Smith, A. P., Gawlik, K. S., Murakami, L., Cooper, J., Koob, S., Wright, K., Cassarino, D., et al. (2022) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12560 · Cited by 37
“…| IMPROVING HYPERTENSION CONTROL AND CARDIOVASCULAR HEALTH: URGENT CALL TO ACTION RNs do not measure BP accurately, it can lead to over/under diagnosis, over/under- treatment, or lack of treatment intensification (Bundy et al., 2017; Johnson et al., 2018; Jones et al., 2003; Piper et al., 2015).”
BackgroundPuberty Timing and Sex-Specific Trajectories of Systolic Blood Pressure: a Prospective Cohort Study
O’Neill, K., Bell, J. A., Smith, G. D., Tilling, K. M., Kearney, P. M., & O’Keeffe, L. M. (2022) · Hypertension · doi:10.1161/hypertensionaha.121.18531 · Cited by 25
Clinical outcomes and economic impact of the 2017 ACC/AHA guidelines on hypertension in China
Wang, Z., Hao, G., Wang, X., Chen, Z., Zhang, L., Zhang, Z., Hu, H., Weintraub, W. S., Gao, R., & for the China hypertension survey investigators (2019) · Journal of Clinical Hypertension · doi:10.1111/jch.13609 · Cited by 25
The Effect Of Home-Based Hypertension Screening On Blood Pressure Change Over Time In South Africa
Sudharsanan, N., Chen, S., Garber, M. D., Bärnighausen, T., & Geldsetzer, P. (2020) · Health Affairs · doi:10.1377/hlthaff.2019.00585 · Cited by 25
Perrier-Melo, R. J., Costa, E. C., Farah, B. Q., & Costa, M. D. C. (2020) · Arquivos Brasileiros de Cardiologia · doi:10.36660/abc.20190107 · Cited by 29
Feng, M., Gu, L., Zeng, Y., Gao, W., Cai, C., Chen, Y. ‐. I., & Guo, X. (2025) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2025.112079 · Cited by 28
Metadata
- Authors
- Bundy, J. D., Li, C., Stuchlik, P., Bu, X., Kelly, T. N., Mills, K. T., He, H., Chen, J., Whelton, P. K., & He, J.
- Affiliations
- Tulane University (US)
- Corresponding author
- He, Jiang
- ORCID
- Venue
- JAMA Cardiology
- Publisher
- American Medical Association (AMA)
- Published
- 2017-07-01
- Volume
- 2
- Issue
- 7
- Pages
- 775
- ISSN
- 2380-6583 (ISSN-L)
- PMC
- PMC5710614
- OpenAlex
- W2618382346
- Cited by
- 783
- References
- 33
- Citations by year
- 2026: 59 · 2025: 102 · 2024: 96 · 2023: 99 · 2022: 65 · 2021: 95 · 2020: 80 · 2019: 78 · 2018: 73 · 2017: 35
- FWCI
- 56.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Cardiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of General Medical Sciences (P20GM109036)
- Fogarty International Center (D43TW009107)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- systolic blood pressure, blood pressure targets, hypertension, antihypertensive therapy, cardiovascular disease, all-cause mortality, blood pressure reduction, linear dose-response relationship, cardiovascular risk reduction, cardiovascular disease prevention, cardiovascular disease prevention and treatment
- MeSH terms
- Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Humans, Hypertension, Mortality, Patient Care Planning, Systole
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