More Versus Less Blood Pressure Lowering: An Update
Open accessAbstract
Purpose This article summarizes the results of a recent systematic review and meta-analysis of the safety and efficacy of intensive blood pressure (BP) lowering, including an update with the SPRINT (Systolic Blood Pressure Intervention Trial) results. We discuss the consistency of results within this set of trials (eg, ACCORD [Action to Control Cardiovascular Risk in Diabetes] and SPRINT) and the results in the context of other BP-lowering trials, including the recently published HOPE3 (Heart Outcomes Prevention Evaluation-3) study.Methods This study was a narrative review with updated meta-analysis from systematic review of trials comparing more- versus less-intensive BP lowering.Findings With the addition of SPRINT, there are >20 trials comparing more- versus less-intensive treatment with 54,350 participants overall. Over an average of 3.9 years of follow-up, the average systolic BP was 133 mm Hg in the more-intensive treatment arms and 140 mm Hg in the less-intensive treatment arms. More-intensive BP lowering reduced the risk of major vascular events, with benefits seen across a range of groups defined according to baseline systolic BP (120-139 mm Hg, 140-159 mm Hg, or ≥160 mm Hg), age (<70 or >70 years), and main entry criterion (hypertension, diabetes, or renal disease).Implications The evidence accumulated thus far provides clear evidence of the benefits of BP lowering in the 120- to 140-mm Hg range for various high-risk patient groups. Although intensive BP lowering has side effects, these trials indicate that the benefits will predominate for those at high risk of major vascular events.
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A 24-hour ambulatory blood pressure mean above 135/85 mm Hg is linked to roughly double the likelihood of a cardiovascular event compared with values below that threshold, independent of office blood pressure.
“Persons whose 24-hour ABPM mean BP exceeds 135/85 mm Hg are nearly twice as likely to have a CV event as those with values that remain <135/85 mm Hg, irrespective of the level of the office BP.”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [229]
The section on recent evidence assessing more- versus less-intensive BP lowering discusses treatment trials and office BP measurement, not 24-hour ambulatory BP. Searches for ABPM, the 135/85 mm Hg threshold, and a near-doubling of cardiovascular-event likelihood independent of office BP found no passage addressing the claim. (LLM, conf=0.75)
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Blonde, L., Umpierrez, G. E., Reddy, S. S., McGill, J. B., Berga, S. L., Bush, M., Chandrasekaran, S., DeFronzo, R. A., Einhorn, D., Galindo, R. J., et al. (2022) · Endocrine Practice · doi:10.1016/j.eprac.2022.08.002 · Cited by 507 · see citing works
- Authors
- Atkins, E. R., & Rodgers, A.
- Affiliations
- The University of Sydney (AU)
- Venue
- Clinical Therapeutics
- Publisher
- Elsevier BV
- Published
- 2016-10
- Volume
- 38
- Issue
- 10
- Pages
- 2135-2141
- ISSN
- 0149-2918 (ISSN-L)
- OpenAlex
- W2520168155
- Cited by
- 12
- References
- 31
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 1 · 2019: 1 · 2018: 5 · 2017: 1 · 2016: 2
- FWCI
- 2.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council
- 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
- intensive blood pressure lowering, systolic blood pressure, SPRINT trial, ACCORD trial, major vascular events, hypertension, diabetes mellitus, kidney disease, antihypertensive therapy, treatment efficacy and safety
- MeSH terms
- Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Diabetes Mellitus, Humans, Hypertension, Kidney Diseases, Risk Factors
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