Cited by 783Blood Pressure and Hypertension StudiesSodium Intake and HealthCardiovascular Health and Disease Prevention

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Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality: A Systematic Review and Network Meta-analysis

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Bundy, Joshua D., Li, Changwei, Stuchlik, Patrick, Bu, Xiaoqing, Kelly, Tanika N., Mills, Katherine T., He, Hua, Chen, Jing, Whelton, Paul K., He, Jiang·2017·JAMA Cardiology

DOI 10.1001/jamacardio.2017.1421PMC PMC5710614

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Abstract

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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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: Bundy, Joshua D.
Li, Changwei
Bu, Xiaoqing
Kelly, Tanika N.
Mills, Katherine T.
He, Hua
Chen, Jing
Whelton, Paul K.
He, Jiang
Venue: JAMA Cardiology
Publisher: American Medical Association (AMA)
Published: 2017-07-01
Volume: 2
Issue: 7
Pages: 775
ISSN: 2380-6583 (ISSN-L)
DOI: 10.1001/jamacardio.2017.1421
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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Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality: A Systematic Review and Network Meta-analysis

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