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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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Narita, K., Hoshide, S., & Kario, K. (2018) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2018.1538784 · Cited by 2
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Tadic, M. V., & Cuspidi, C. (2019) · Journal of Clinical Hypertension · doi:10.1111/jch.13607 · Cited by 2
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Singh, A., & Ramkumar, K. R. (2021) · International Journal of Knowledge-based and Intelligent Engineering Systems · doi:10.3233/kes-210065 · Cited by 2
Muntner, P. (2021) · American Journal of Hypertension · doi:10.1093/ajh/hpab188 · Cited by 2
Blood Pressure Screening in Faith Communities
Sailors, R., Saint, D., & Ayer, N. (2022) · Journal of Christian Nursing · doi:10.1097/cnj.0000000000000982 · Cited by 2
Soomro, S., & Yu, K. (2024) · Journal of Applied Statistics · doi:10.1080/02664763.2024.2359526 · Cited by 2
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Jones, D. W. (2018) · Journal of Clinical Hypertension · doi:10.1111/jch.13324 · Cited by 2
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Beddhu, S., & Whelton, P. K. (2020) · Hypertension · doi:10.1161/hypertensionaha.120.14784 · Cited by 2
Self-citationNetwork meta-analyses in hypertension
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“…with ischemic heart disease, cerebrovascular disease, and chronic kidney disease attributed to increased systolic blood pressure (sBP, ≥ 140 mmHg) (Bundy et al. 2017; Mills et al. 2020; Webb and Werring 2022), efficacious prevention, treatment, and management approaches are needed to address…”
Wang, F., Jia, B., Li, G., Jin, X., Yang, M., Li, G., Zhang, S., Qian, G., Luo, H., Cheng, M. H., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-090230 · Cited by 1
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“…therapy lowered the risk of the primary composite outcome (myocardial infarction, stroke, heart failure, or cardiovascular death) by 25%, all-cause mortality by 27%, heart failure by 38%, cardiovascular death by 43%, and the combined endpoint of the primary outcome or death by 22% [41].”
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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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