Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels – updated overview and meta-analyses of randomized trials

Thomopoulos, Costas; Parati, Gianfranco; Zanchetti, Alberto

doi:10.1097/hjh.0000000000000881

Cited by 298Blood Pressure and Hypertension StudiesSodium Intake and HealthCardiovascular Health and Disease Prevention

Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels – updated overview and meta-analyses of randomized trials

Thomopoulos, Costas, Parati, Gianfranco, Zanchetti, Alberto·2016·Journal of Hypertension

DOI 10.1097/hjh.0000000000000881

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Abstract

BACKGROUND AND OBJECTIVES: Previous meta-analyses of our group have investigated the cardiovascular effects of more vs. less intense blood pressure (BP) treatment and the BP levels to be achieved by treatment. A few additional trials have been completed recently, particularly the large SPRINT study. Updating of the previous meta-analyses has been done with the objective of further clarifying the practical question of BP targets of antihypertensive treatment. METHODS: Among randomized-controlled trials (RCTs) of BP lowering treatment between 1966 and 2015, 16 (52 235 patients) compared more vs. less intense treatment and fulfilled other preset criteria, and in 34 (138 127 patients) SBP in the active (vs. placebo) or the more (vs. less) intense treatment was below (vs., respectively, above) three predetermined cutoffs. For their meta-analyses risk ratios (RR) and 95% confidence intervals, standardized to -10/-5 mmHg SBP/DBP reduction, and absolute risk reductions of seven fatal and nonfatal outcomes were calculated. RESULTS: More intense BP lowering significantly reduced risk of stroke [RR 0.71 (0.60-0.84)], coronary events [0.80 (0.68-0.95)], major cardiovascular events [0.75 (0.68-0.85)] and cardiovascular mortality [0.79 (0.63-0.97)], but not heart failure and all-cause death. When the 16 RCTs were stratified according to cardiovascular death risk, relative risk reduction did not differ between strata, but absolute risk reduction increased with cardiovascular risk, though the residual risk also increased. Stratification of the 34 RCTs according to the three different SBP cutoffs (150, 140 and 130 mmHg) showed that a SBP/DBP difference of -10/-5 mmHg across each cutoff significantly reduced risk of all outcomes to the same proportion (relative risk reduction), but absolute risk reduction of most outcomes had a significant trend to decrease at lower cutoffs. CONCLUSION: Updating of previous meta-analyses indicates that more vs. less intense BP lowering can reduce not only stroke and coronary events, but also cardiovascular mortality. Including data from recent RCTs also shows that all major outcomes can be reduced by lowering SBP a few mmHg below vs. above 130 mmHg, but absolute risk reduction becomes smaller, suggesting patients at lower initial SBP were at a lower level of cardiovascular risk.

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In the Ohasama study, changing the thresholds did not have relevant impact on the relationship of these categories with outcome.
“Although in the Ohasama study, changing the thresholds did not have relevant impact on the relationship of these categories with outcome [150]”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [150]
Such lower threshold has a substantial impact on the relative prevalence of sustained, masked and white-coat hypertension.
“Of note, such lower threshold has a substantial impact on the relative prevalence of sustained, masked and white-coat hypertension [150]”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [150]

Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies
(2002) · The Lancet · doi:10.1016/s0140-6736(02)11911-8 · Cited by 10,266 · see citing works
2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., Lackland, D. T., LeFevre, M. L., MacKenzie, T. D., Ogedegbe, O., et al. (2014) · JAMA · doi:10.1001/jama.2013.284427 · Cited by 7,950 · see citing works
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38
(1998) · BMJ · doi:10.1136/bmj.317.7160.703 · Cited by 6,683 · see citing works
A Randomized Trial of Intensive versus Standard Blood-Pressure Control
The SPRINT Research Group (2015) · New England Journal of Medicine · doi:10.1056/nejmoa1511939 · Cited by 6,325 · see citing works
Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the hypertension optimal treatment (HOT) randomised trial
Hansson, L., Zanchetti, A., Carruthers, S. G., Dahlöf, B., Elmfeldt, D., Julius, S., Ménard, J., Rahn, K. H., Wedel, H., & Westerling, S. (1998) · The Lancet · doi:10.1016/s0140-6736(98)04311-6 · Cited by 5,728 · see citing works
Self-citation
2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., Böhm, M., Christiaens, T., Cifkova, R., De Backer, G., Dominiczak, A., et al. (2013) · Journal of Hypertension · doi:10.1097/01.hjh.0000431740.32696.cc · Cited by 5,655 · see citing works
Self-citation
Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38
Stearne, M. R., Palmer, S. L., Hammersley, M. S., Franklin, S. L., Spivey, R. S., Lévy, J., Tidy, C. R., Bell, N. J., Steemson, J., Barrow, B. A., et al. (1998) · UCL Discovery (University College London) · Cited by 4,803 · see citing works
Effects of intensive blood-pressure control in type 2 diabetes mellitus
(2010) · New England Journal of Medicine · doi:10.1056/nejmoa1001286 · Cited by 3,598 · see citing works
Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy
(2000) · The Lancet · doi:10.1016/s0140-6736(99)12323-7 · Cited by 3,179 · see citing works
Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack
(2001) · The Lancet · doi:10.1016/s0140-6736(01)06178-5 · Cited by 3,178 · see citing works
Treatment of hypertension in patients 80 years of age or older
Beckett, N. S., Peters, R., Fletcher, A. E., Staessen, J. A., Liu, L., Dumitrascu, D., Stoyanovsky, V., Antikainen, R. L., Nikitin, Y., Anderson, C., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0801369 · Cited by 3,092 · see citing works
Prevention of Stroke by Antihypertensive Drug Treatment in Older Persons With Isolated Systolic Hypertension: Final Results of the Systolic Hypertension in the Elderly Program (SHEP)
(1991) · JAMA · doi:10.1001/jama.1991.03460240051027 · Cited by 2,953 · see citing works
Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials
(2003) · The Lancet · doi:10.1016/s0140-6736(03)14739-3 · Cited by 2,402 · see citing works
Effect of the Angiotensin-Converting–Enzyme Inhibitor Benazepril on the Progression of Chronic Renal Insufficiency
Maschio, G., Alberti, D., Janin, G., Locatelli, F., Mann, J. F. E., Motolese, M., Ponticelli, C. E., Ritz, E., & Zucchelli, P. C. (1996) · New England Journal of Medicine · doi:10.1056/nejm199604113341502 · Cited by 1,743 · see citing works
Effects Morbidity of Treatment on in Hypertension
Veterans Administration Cooperative Study Group on Antihypertensive Agents (1970) · JAMA · doi:10.1001/jama.213.7.1143 · Cited by 1,737 · see citing works
MRC trial of treatment of mild hypertension: principal results. Medical Research Council Working Party.
(1985) · BMJ · doi:10.1136/bmj.291.6488.97 · Cited by 1,491 · see citing works
MORTALITY AND MORBIDITY RESULTS FROM THE EUROPEAN WORKING PARTY ON HIGH BLOOD PRESSURE IN THE ELDERLY TRIAL*1, *2
Amery, A. (1985) · The Lancet · doi:10.1016/s0140-6736(85)91783-0 · Cited by 1,484 · see citing works
Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg
(1967) · JAMA · doi:10.1001/jama.202.11.1028 · Cited by 1,317 · see citing works
Five-Year Findings of the Hypertension Detection and Follow-up Program: I. Reduction in Mortality of Persons With High Blood Pressure, Including Mild Hypertension
(1979) · JAMA · doi:10.1001/jama.1979.03300230018021 · Cited by 1,246 · see citing works
Effects of Treatment on Morbidity in Hypertension: Results in Patients With Diastolic Blood Pressures Averaging 115 Through 129 mm Hg
(1967) · JAMA · doi:10.1001/jama.1967.03130240070013 · Cited by 1,127 · see citing works
Angiotensin-converting-enzyme inhibition in stable coronary artery disease
(2004) · New England Journal of Medicine · doi:10.1056/nejmoa042739 · Cited by 1,123 · see citing works
Preventing Microalbuminuria in Type 2 Diabetes
Ruggenenti, P. L., Fassi, A., Parvanova, A. I., Bruno, S., Iliev, I. P., Brusegan, V., Rubis, N., Gherardi, G., Arnoldi, F., Ganeva, M. G., et al. (2004) · New England Journal of Medicine · doi:10.1056/nejmoa042167 · Cited by 1,012 · see citing works
Strict Blood-Pressure Control and Progression of Renal Failure in Children
The ESCAPE Trial Group (2009) · New England Journal of Medicine · doi:10.1056/nejmoa0902066 · Cited by 951 · see citing works
Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group
Neaton, J. D. (1993) · JAMA · doi:10.1001/jama.270.6.713 · Cited by 949 · see citing works
Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes
Schrier, R. W., Estacio, R. O., Esler, A. L., & Mehler, P. S. (2002) · Kidney International · doi:10.1046/j.1523-1755.2002.00213.x · Cited by 843 · see citing works
Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial
* (2013) · The Lancet · doi:10.1016/s0140-6736(13)60852-1 · Cited by 751 · see citing works
Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease
Appel, L. J., Wright, J. T., Greene, T., Agodoa, L. Y. C., Astor, B. C., Bakris, G. L., Cleveland, W. H., Charleston, J. B., Contreras, G. N., Faulkner, M. L., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa0910975 · Cited by 719 · see citing works
Untitled work
(2000) · PubMed · Cited by 691 · see citing works
Clinical Practice Guidelines for the Management of Hypertension in the Community
Weber, M. A., Schiffrin, E. L., White, W. B., Mann, S. J., Lindholm, L. H., Kenerson, J. G., Flack, J. M., Carter, B. L., Materson, B. J., Ram, C. V. S., et al. (2013) · Journal of Hypertension · doi:10.1097/hjh.0000000000000065 · Cited by 681 · see citing works
Treatment of Mild Hypertension Study
Neaton, J. D. (1993) · JAMA · doi:10.1001/jama.1993.03510060059034 · Cited by 669 · see citing works
Treatment of mild hypertension: A five year controlled drug trial
Helgeland, A. (1980) · The American Journal of Medicine · doi:10.1016/0002-9343(80)90438-6 · Cited by 646 · see citing works
Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial
Ruggenenti, P. L., Perna, A., Loriga, G., Ganeva, M. G., Ene‐Iordache, B., Turturro, M., Lesti, M., Perticucci, E., Chakarski, I. N., Leonardis, D., et al. (2005) · The Lancet · doi:10.1016/s0140-6736(05)71082-5 · Cited by 636 · see citing works
Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data
(2014) · The Lancet · doi:10.1016/s0140-6736(14)61212-5 · Cited by 623 · see citing works
Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease
Collins, R., & MacMahon, S. W. (1994) · British Medical Bulletin · doi:10.1093/oxfordjournals.bmb.a072892 · Cited by 585 · see citing works
The Effect of a Lower Target Blood Pressure on the Progression of Kidney Disease: Long-Term Follow-up of the Modification of Diet in Renal Disease Study
Sarnak, M. J., Greene, T., Wang, X., Beck, G. J., Kusek, J. W., Collins, A. J., & Levey, A. S. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-142-5-200503010-00009 · Cited by 508 · see citing works
Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension (Cardio-Sis): an open-label randomised trial
Verdecchia, P., Staessen, J. A., Angeli, F., SIMONE, G. D., Achilli, A., Ganau, A., Mureddu, G., Pede, S., Maggioni, A. P., Lucci, D., et al. (2009) · The Lancet · doi:10.1016/s0140-6736(09)61340-4 · Cited by 435 · see citing works
Principal Results of the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS)
JATOS Study Group (2008) · Hypertension Research · doi:10.1291/hypres.31.2115 · Cited by 397 · see citing works
The Felodipine Event Reduction (FEVER) Study: a randomized long-term placebo-controlled trial in Chinese hypertensive patients
Liu, L., Zhang, Y., Liu, G., Li, W., Zhang, X., & Zanchetti, A. (2005) · Journal of Hypertension · doi:10.1097/01.hjh.0000194120.42722.ac · Cited by 389 · see citing works
Self-citation
Effects of blood pressure lowering on outcome incidence in hypertension. 1. Overview, meta-analyses, and meta-regression analyses of randomized trials
Thomopoulos, C., Parati, G., & Zanchetti, A. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000378 · Cited by 388 · see citing works
Self-citation
Target Blood Pressure for Treatment of Isolated Systolic Hypertension in the Elderly
Ogihara, T., Saruta, T., Rakugi, H., Matsuoka, H., Shimamoto, K., Shimada, K., Imai, Y., Kikuchi, K., Ito, S., Eto, T., et al. (2010) · Hypertension · doi:10.1161/hypertensionaha.109.146035 · Cited by 370 · see citing works
Treatment of mild hypertension: results of a ten-year intervention trial.
Wm, S. (1977) · PubMed · Cited by 243 · see citing works
Effect of Lower Targets for Blood Pressure and LDL Cholesterol on Atherosclerosis in Diabetes
Howard, B. V. (2008) · JAMA · doi:10.1001/jama.299.14.1678 · Cited by 241 · see citing works
Alterations in canine myocardial excitability during ischemia.
Elharrar, V., Foster, P. R., Jirak, T. L., Gaum, W. E., & Zipes, D. P. (1977) · Circulation Research · doi:10.1161/01.res.40.1.98 · Cited by 235 · see citing works
Effect of Antihypertensive Treatment on Stroke Recurrence
(1974) · JAMA · doi:10.1001/jama.1974.03230420021019 · Cited by 229 · see citing works
Cardiac and Renal Effects of Standard Versus Rigorous Blood Pressure Control in Autosomal-Dominant Polycystic Kidney Disease
Schrier, R. W., McFann, K. K., Johnson, A., Chapman, A. B., Edelstein, C. L., Brosnahan, G., Ecder, T., & Tison, L. O. (2002) · Journal of the American Society of Nephrology · doi:10.1097/01.asn.0000018407.60002.b9 · Cited by 197 · see citing works
Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure
on behalf of Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) investigators, Asayama, K., Ohkubo, T., Metoki, H., Obara, T., Inoue, R., Kikuya, M., Thijs, L., Staessen, J. A., & Imai, Y. (2012) · Hypertension Research · doi:10.1038/hr.2012.125 · Cited by 186 · see citing works
Untitled work
Dagenais (2008) · doi:10.2337/dc07-1868 · Cited by 183 · see citing works
“Strict” blood pressure control and progression of renal disease in hypertensive nephrosclerosis
Toto, R. D., Mitchell, H. C., Smith, R. D., Lee, H.-C., McIntire, D. D., & Pettinger, W. A. (1995) · Kidney International · doi:10.1038/ki.1995.361 · Cited by 164 · see citing works
Effects of blood pressure lowering on outcome incidence in hypertension: 2. Effects at different baseline and achieved blood pressure levels – overview and meta-analyses of randomized trials
Thomopoulos, C., Parati, G., & Zanchetti, A. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000379 · Cited by 162 · see citing works
Self-citation
Morbidity and mortality in the Systolic Hypertension in the Elderly Program (SHEP) pilot study.
Perry, H. M., Smith, W. M., McDonald, R. H., Black, D. M., Cutler, J. A., Furberg, C. D., Greenlick, M. R., Kuller, L. H., Schnaper, H. W., & Schoenberger, J. A. (1989) · Stroke · doi:10.1161/01.str.20.1.4 · Cited by 129 · see citing works
Effects of blood pressure lowering on outcome incidence in hypertension
Thomopoulos, C., Parati, G., & Zanchetti, A. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000380 · Cited by 124 · see citing works
Self-citation
Effects of blood pressure-lowering treatment. 6. Prevention of heart failure and new-onset heart failure – meta-analyses of randomized trials
Thomopoulos, C., Parati, G., & Zanchetti, A. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000000848 · Cited by 99 · see citing works
Self-citation
Effect of Intensive Blood Pressure Control With Valsartan on Urinary Albumin Excretion in Normotensive Patients With Type 2 Diabetes
Estacio, R., Coll, J. R., Tran, Z. V., & Schrier, R. W. (2006) · American Journal of Hypertension · doi:10.1016/j.amjhyper.2006.05.011 · Cited by 97 · see citing works
Effects of amlodipine fosinopril combination on microalbuminuria in hypertensive type 2 diabetic patients
Fogari, R. (2002) · American Journal of Hypertension · doi:10.1016/s0895-7061(02)03017-0 · Cited by 94 · see citing works
Effects of Intensive Antihypertensive Treatment on Chinese Hypertensive Patients Older Than 70 Years
Wei, Y. Q., Jin, Z., Shen, G., Zhao, X., Yang, W.-H., ye, Z., & Wang, J. (2013) · Journal of Clinical Hypertension · doi:10.1111/jch.12094 · Cited by 90 · see citing works
Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient
Zanchetti, A., Liu, L., Mancia, G., Parati, G., Grassi, G. M., Stramba‐Badiale, M., Silani, V., Bilo, G., Corrao, G., Zambon, A., et al. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000254 · Cited by 75 · see citing works
Self-citation
Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial
Huisman, M. V. (2007) · Netherlands Heart Journal · doi:10.1007/bf03086059 · Cited by 67 · see citing works
The BBB Study: The Effect of Intensified Antihypertensive Treatment on the Level of Blood Pressure, Side-Effects, Morbidity and Mortality in “Well-Treated” Hypertensive Patients
Hansson, L. (1994) · Blood Pressure · doi:10.3109/08037059409102265 · Cited by 66 · see citing works
Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline
Zanchetti, A., Liu, L., Mancia, G., Parati, G., Grassi, G. M., Stramba‐Badiale, M., Silani, V., Bilo, G., Corrao, G., Zambon, A., et al. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000253 · Cited by 39 · see citing works
Self-citation
Continuation of the ESH-CHL-SHOT trial after publication of the SPRINT
Zanchetti, A., Liu, L., Mancia, G., Parati, G., Grassi, G. M., Stramba‐Badiale, M., Silani, V., Bilo, G., Corrao, G., Zambon, A., et al. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000000853 · Cited by 29 · see citing works
Self-citation
DISULPHATE OF QUININE.
Collier, G. (1842) · The Lancet · doi:10.1016/s0140-6736(00)33349-9 · Cited by 13 · see citing works

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2018 ESC/ESH Guidelines for the management of arterial hypertension
Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D. L., Coca, A., de Simone, G., Dominiczak, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy339 · Cited by 10,286 · see citing works
Self-citation
Heart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association
Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000757 · Cited by 9,175 · see citing works
Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association
Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Das, S. R., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000659 · Cited by 9,036 · see citing works
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000065 · Cited by 7,391 · see citing works
Heart disease and stroke statistics-2018 update: a report from the american heart association
Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., Chiuve, S. E., Cushman, M., Delling, F. N., Deo, R., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000558 · Cited by 7,146 · see citing works
2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Benetos, A., Biffi, A., Boavida, J.-M., Capodanno, D., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab484 · Cited by 6,485 · see citing works
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.11.006 · Cited by 6,616 · see citing works
Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association
Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Cheng, S., Delling, F. N., et al. (2021) · Circulation · doi:10.1161/cir.0000000000000950 · Cited by 5,784 · see citing works
2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000678 · Cited by 4,536 · see citing works
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Hypertension · doi:10.1161/hyp.0000000000000066 · Cited by 4,347 · see citing works
2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)
Mancia, G., Kreutz, R., Brunström, M., Burnier, M., Grassi, G., Januszewicz, A., Muiesan, M. L., Tsioufis, K., Agabiti-Rosei, E., Algharably, E. A. E., et al. (2023) · Journal of Hypertension · doi:10.1097/hjh.0000000000003480 · Cited by 3,473 · see citing works
Self-citation
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure
Yancy, C. W., Jessup, M. L., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., Drazner, M. H., Filippatos, G. S., Fonarow, G. C., Givertz, M. M., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.04.025 · Cited by 3,476 · see citing works
“2016 (96) 26848994 Meta-analysis of RCT’s of more versus less intense BP control 16 trials (52,235 pts) compared more vs.”
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., Drazner, M. H., Filippatos, G. S., Fonarow, G. C., Givertz, M. M., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000509 · Cited by 3,109 · see citing works
2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension
Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D. L., Coca, A., de Simone, G., Dominiczak, A., et al. (2018) · Journal of Hypertension · doi:10.1097/hjh.0000000000001940 · Cited by 2,885 · see citing works
Self-citation
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.03.010 · Cited by 1,896 · see citing works
The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019)
Umemura, S., Arima, H., Arima, S., Asayama, K., Dohi, Y., Hirooka, Y., Horio, T., Hoshide, S., Ikeda, S., Ishimitsu, T., et al. (2019) · Hypertension Research · doi:10.1038/s41440-019-0284-9 · Cited by 1,880 · see citing works
2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes.
Marx, N., Federici, M., Schütt, K., Müller-Wieland, D., Ajjan, R. A., Antunes, M. J., Christodorescu, R. M., Crawford, C., Di Angelantonio, E., Eliasson, B., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad192 · Cited by 1,642 · see citing works
Self-citation
2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents
Lurbe, E., Agabiti-Rosei, E., Cruickshank, J. K., Dominiczak, A., Erdine, S., Hirth, A., Invitti, C., Litwin, M., Mancia, G., Pall, D., et al. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000001039 · Cited by 1,379 · see citing works
Self-citation
2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary
Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., Himmelfarb, C. D., Khera, A., Lloyd-Jones, D., McEvoy, J. W., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.03.009 · Cited by 1,193 · see citing works
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000596 · Cited by 1,127 · see citing works
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., DePalma, S. M., Gidding, S. S., Jamerson, K., Jones, D. W., et al. (2018) · Circulation · doi:10.1161/cir.0000000000000597 · Cited by 989 · see citing works
“, 2016 (54) 26848994 Study type: Metaanalysis of RTCs of more vs.”
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., DePalma, S. M., Gidding, S. S., Jamerson, K., Jones, D. W., et al. (2018) · Journal of the American Society of Hypertension · doi:10.1016/j.jash.2018.06.010 · Cited by 947 · see citing works
Potential US Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline
Muntner, P., Carey, R. M., Gidding, S. S., Jones, D. W., Taler, S. J., Wright, J. T., & Whelton, P. K. (2017) · Circulation · doi:10.1161/circulationaha.117.032582 · Cited by 942 · see citing works
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., DePalma, S. M., Gidding, S. S., Jamerson, K., Jones, D. W., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.11.005 · Cited by 934 · see citing works
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure
Yancy, C. W., Jessup, M. L., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., Drazner, M. H., Filippatos, G. S., Fonarow, G. C., Givertz, M. M., et al. (2017) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2017.04.014 · Cited by 769 · see citing works
Untitled work
(2019) · doi:10.1161/cir.0000000000000677 · Cited by 4,501 · see citing works
2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Bénétos, A., Biffi, A., Boavida, J.-M., Capodanno, D., et al. (2021) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwab154 · Cited by 565 · see citing works
Arterial hypertension in adults. Clinical guidelines 2020
Kobalava, Z. D., Конради, А. О., Nedogoda, S. V., Shlyakhto, E. V., Arutyunov, G. P., Баранова, Е. И., Барбараш, О. Л., Бойцов, С. А., Вавилова, Т. В., Вадимовна, В. С., et al. (2020) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2020-3-3786 · Cited by 599 · see citing works
Dietary approaches to stop hypertension (DASH) diet and blood pressure reduction in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials
Filippou, C. D., Tsioufis, C. P., Thomopoulos, C. G., Mihas, C. C., Dimitriadis, K. S., Sotiropoulou, L. I., Chrysochoou, C. A., Nihoyannopoulos, P. I., & Tousoulis, D. M. (2020) · Advances in Nutrition · doi:10.1093/advances/nmaa041 · Cited by 539 · see citing works
Self-citation
Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline
Carey, R. M., & Whelton, P. K. (2018) · Annals of Internal Medicine · doi:10.7326/m17-3203 · Cited by 519 · see citing works
Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels
Brunström, M., & Carlberg, B. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.6015 · Cited by 468 · see citing works
Potential U.S. Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline
Muntner, P., Carey, R. M., Gidding, S., Jones, D. W., Taler, S. J., Wright, J. T., & Whelton, P. K. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.10.073 · Cited by 339 · see citing works
“reduction benefits.(19-26) Nonpharmacological therapy on its own is the recommended treatment for”
2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Jones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., et al. (2025) · Hypertension · doi:10.1161/hyp.0000000000000249 · Cited by 386 · see citing works
Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial
Mahfoud, F., Kandzari, D. E., Kario, K., Townsend, R. R., Weber, M. A., Schmieder, R. E., Tsioufis, K. P., Pocock, S., Dimitriadis, K. S., Choi, J. W., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00455-x · Cited by 305 · see citing works
Diagnosis and treatment of arterial hypertension [Guidelines]
Chazova, I. E., & Zhernakova, Y. V. (2019) · Systemic Hypertension · doi:10.26442/2075082x.2019.1.190179 · Cited by 283 · see citing works
2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension
Lee, H., Shin, J., Kim, G., Park, S., Ihm, S., Kim, H. C., Kim, K., Kim, J. H., Lee, J. H., Park, J., et al. (2019) · Clinical Hypertension · doi:10.1186/s40885-019-0124-x · Cited by 271 · see citing works
2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
Jones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., et al. (2025) · JACC · doi:10.1016/j.jacc.2025.05.007 · Cited by 280 · see citing works
Precision medicine in cardiology
Antman, E. M., & Loscalzo, J. (2016) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2016.101 · Cited by 251 · see citing works
ESVM Guideline on peripheral arterial disease
Frank, U., Nikol, S., Belch, J. J. F., Boc, V., Brodmann, M., Carpentier, P., Chraim, A., Canning, C., Dimakakos, E. P., Gottsäter, A., et al. (2019) · VASA · doi:10.1024/0301-1526/a000834 · Cited by 251 · see citing works
Blood Pressure Measurement in SPRINT (Systolic Blood Pressure Intervention Trial)
Johnson, K., Whelton, P. K., Cushman, W. C., Cutler, J. A., Evans, G. W., Snyder, J. K., Ambrosius, W. T., Beddhu, S., Cheung, A. K., Fine, L. J., et al. (2018) · Hypertension · doi:10.1161/hypertensionaha.117.10479 · Cited by 241 · see citing works
2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Jones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., Abdalla, M., Altieri, M. M., Bansal, N., Bello, N. A., Bress, A. P., et al. (2025) · Circulation · doi:10.1161/cir.0000000000001356 · Cited by 295 · see citing works
Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
Reboussin, D. M., Allen, N. B., Griswold, M. E., Guallar, E., Hong, Y., Lackland, D. T., Miller, E. (. R., Polonsky, T., Thompson-Paul, A. M., & Vupputuri, S. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.11.004 · Cited by 221 · see citing works
“Similar to our findings, CCBs have previously been found to be associated with higher risk of heart failure and beta blockers with a higher risk of stroke (37, 83, 85).”
BackgroundMethodResultInfluential
Disorders of lipid metabolism. Clinical Guidelines 2023
Владиславович, Е. М., Kukharchuk, V. V., Сергиенко, И. В., Alieva, A. S., Antsiferov, M. B., Ansheles, A. A., Arabidze, G. G., Dm, A., Arutyunov, G. P., Ахмеджанов, Н. М., et al. (2023) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2023-5471 · Cited by 260 · see citing works
2024 Clinical practice guidelines for Hypertension in adults
Кобалава, Ж. Д., Конради, А. О., Nedogoda, S. V., Shlyakhto, E. V., Arutyunov, G. P., Баранова, Е. И., Барбараш, О. Л., Bobkova, N. V., Boytsov, S. A., Bubnova, M. G., et al. (2024) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2024-6117 · Cited by 260 · see citing works
Personalized exercise prescription in the prevention and treatment of arterial hypertension: a Consensus Document from the European Association of Preventive Cardiology (EAPC) and the ESC Council on Hypertension.
Hanssen, H., Boardman, H., Deiseroth, A., Moholdt, T., Simonenko, M., Kränkel, N., Niebauer, J., Tiberi, M., Abreu, A., Solberg, E., et al. (2021) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaa141 · Cited by 194 · see citing works
Hypertension management in patients with cardiovascular comorbidities
Lauder, L., Mahfoud, F., Azizi, M., Bhatt, D. L., Ewen, S., Kario, K., Parati, G., Rossignol, P., Schlaich, M. P., Teo, K. K., et al. (2022) · European Heart Journal · doi:10.1093/eurheartj/ehac395 · Cited by 217 · see citing works
Self-citation
Effects of blood-pressure-lowering treatment on outcome incidence in hypertension: 10 – Should blood pressure management differ in hypertensive patients with and without diabetes mellitus? Overview and meta-analyses of randomized trials
Thomopoulos, C., Parati, G., & Zanchetti, A. (2017) · Journal of Hypertension · doi:10.1097/hjh.0000000000001276 · Cited by 206 · see citing works
Self-citation
The global burden of hypertension exceeds 1.4 billion people
Egan, B. M., Kjeldsen, S. E., Grassi, G. M., Esler, M., & Mancia, G. (2019) · Journal of Hypertension · doi:10.1097/hjh.0000000000002021 · Cited by 197 · see citing works
“In the meta-analysis by Thomopoulos and co-authors,(11) mean in-trial SBP <130 was linked with significantly lower rates of myocardial infarction, stroke, heart failure and cardiovascular death than in-trial SBP ≥130.(12) Other considerations.”
Method
Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension
Parati, G., Stergiou, G. S., Bilo, G., Kollias, A., Pengo, M., Ochoa, J. E., Agarwal, R., Asayama, K., Asmar, R., Burnier, M., et al. (2021) · Journal of Hypertension · doi:10.1097/hjh.0000000000002922 · Cited by 178 · see citing works
“In recent United States and European guidelines, new and lower OBP targets were proposed based on the evidence from observational studies, from few specifically designed interventional trials, in particular SPRINT [152], and from recent metaanalyses [153,154].”
Self-citation
RSSDI-ESI clinical practice recommendations for the management of type 2 diabetes mellitus 2020
Madhu, S., Chawla, R., Makkar, B. M., Ghosh, S. K., Saboo, B., & Kalra, S. (2020) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/ijem.ijem_225_20 · Cited by 175 · see citing works
“stroke event, albeit with greater adverse effects.[350,585,586]”
Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients: The Million Hearts Longitudinal ASCVD Risk Assessment Tool: A Special Report From the American Heart Association and American College of Cardiology
Lloyd‐Jones, D. M., Huffman, M. D., Karmali, K. N., Sanghavi, D. M., Wright, J. S., Pelser, C. B., Gulati, M., Masoudi, F. A., & Goff, D. C. (2016) · Circulation · doi:10.1161/cir.0000000000000467 · Cited by 165 · see citing works
The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension
Kim, H., Lee, E. M., Ahn, S. Y., Kim, K., Kim, H. C., Kim, J. H., Lee, H., Lee, J. H., Park, J., Cho, E. J., et al. (2023) · Clinical Hypertension · doi:10.1186/s40885-023-00234-9 · Cited by 167 · see citing works
Chinese Guidelines for the Prevention and Treatment of Hypertension (2024 revision)
Wang, J. (2025) · 老年心脏病学杂志：英文版 · doi:10.26599/1671-5411.2025.01.008 · Cited by 169 · see citing works
Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Reboussin, D. M., Allen, N. B., Griswold, M. E., Guallar, E., Hong, Y., Lackland, D. T., Miller, E. (. R., Polonsky, T., Thompson-Paul, A. M., & Vupputuri, S. (2018) · Hypertension · doi:10.1161/hyp.0000000000000067 · Cited by 175 · see citing works
“Similar to our findings, CCBs have previously been found to be associated with higher risk of heart failure and beta blockers with a higher risk of stroke.(37,83,85) Understanding the benefits of one antihypertensive drug class versus another is of critical importance in determining which first-line medication should…”
Result
Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Reboussin, D. M., Allen, N. B., Griswold, M. E., Güallar, E., Hong, Y., Lackland, D. T., Miller, E. R., Polonsky, T. S., Thompson‐Paul, A. M., & Vupputuri, S. X. (2018) · Circulation · doi:10.1161/cir.0000000000000601 · Cited by 142 · see citing works
Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: An Endocrine Society* Clinical Practice Guideline
Rosenzweig, J. L., Bakris, G. L., Berglund, L., Hivert, M., Horton, E. S., Kalyani, R. R., Murad, M. H., & Vergès, B. L. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2019-01338 · Cited by 131 · see citing works
Proceedings from the 2nd European Clinical Consensus Conference for device-based therapies for hypertension: state of the art and considerations for the future
Mahfoud, F., Schmieder, R. E., Azizi, M., Pathak, A., Sievert, H., Tsioufis, C. P., Zeller, T., Bertog, S. C., Blankestijn, P. J., Böhm, M., et al. (2017) · European Heart Journal · doi:10.1093/eurheartj/ehx215 · Cited by 124 · see citing works
“Finally, a recent meta-analysis of intervention trials on the effects of more or less intense BP lowering on outcome, which included SPRINT data, has provided evidence that a significant reduction in the absolute risk of events occurred whenever systolic BP was reduced below 150, 140, or even 130 mmHg, although the ab…”
ResultSelf-citation
Potential Deaths Averted and Serious Adverse Events Incurred From Adoption of the SPRINT (Systolic Blood Pressure Intervention Trial) Intensive Blood Pressure Regimen in the United States
Bress, A. P., Kramer, H., Khatib, R., Beddhu, S., Cheung, A. K., Hess, R., Bansal, V., Cao, G., Yee, J., Moran, A. E., et al. (2017) · Circulation · doi:10.1161/circulationaha.116.025322 · Cited by 119 · see citing works
Effects of blood-pressure-lowering treatment on outcome incidence. 12. Effects in individuals with high-normal and normal blood pressure
Thomopoulos, C., Parati, G., & Zanchetti, A. (2017) · Journal of Hypertension · doi:10.1097/hjh.0000000000001547 · Cited by 119 · see citing works
Self-citation
Mediterranean diet and blood pressure reduction in adults with and without hypertension: A systematic review and meta-analysis of randomized controlled trials
Filippou, C. D., Thomopoulos, C., Kouremeti, M., Sotiropoulou, L., Nihoyannopoulos, P., Tousoulis, D. M., & Tsioufis, C. P. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.01.030 · Cited by 122 · see citing works
Self-citation
Dairy consumption, systolic blood pressure, and risk of hypertension: Mendelian randomization study
Ding, M., Huang, T., Bergholdt, H. K. M., Nordestgaard, B. G., Ellervik, C., & Qi, L. (2017) · BMJ · doi:10.1136/bmj.j1000 · Cited by 108 · see citing works
Chinese Guideline on the Primary Prevention of Cardiovascular Diseases
Chinese Society of Cardiology of Chinese Medical Association, C. D. P. A. R. C. O. C. A. O. R. M. (2021) · Cardiology Discovery · doi:10.1097/cd9.0000000000000025 · Cited by 109 · see citing works
2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures
Casey, D. E., Thomas, R. J., Bhalla, V., Commodore-Mensah, Y. Y., Heidenreich, P. A., Kolte, D. S., Muntner, P., Smith, S. C., Spertus, J. A., Windle, J. R., et al. (2019) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/hcq.0000000000000057 · Cited by 100 · see citing works
Effects of blood-pressure-lowering treatment in hypertension
Thomopoulos, C., Parati, G., & Zanchetti, A. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000001052 · Cited by 100 · see citing works
Self-citation
2019 Chinese guideline for the management of hypertension in the elderly.
Hua, Q., Fan, L. H., & Li, J. (2019) · PubMed Central · doi:10.11909/j.issn.1671-5411.2019.02.001 · Cited by 97 · see citing works
Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients
Lloyd‐Jones, D. M., Huffman, M. D., Karmali, K. N., Sanghavi, D. M., Wright, J. S., Pelser, C. B., Gulati, M., Masoudi, F. A., & Goff, D. C. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.10.018 · Cited by 96 · see citing works
Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality
Thomopoulos, C., Parati, G., & Zanchetti, A. (2018) · Journal of Hypertension · doi:10.1097/hjh.0000000000001777 · Cited by 95 · see citing works
Self-citation
Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality
Thomopoulos, C., Parati, G., & Zanchetti, A. (2018) · Journal of Hypertension · doi:10.1097/hjh.0000000000001787 · Cited by 90 · see citing works
Self-citation
Effects of blood pressure lowering treatment in hypertension
Thomopoulos, C., Parati, G., & Zanchetti, A. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000000972 · Cited by 79 · see citing works
Self-citation
Guía ESC 2021 sobre la prevención de la enfermedad cardiovascular en la práctica clínica
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Bénétos, A., Biffi, A., Boavida, J. M., Capodanno, D., et al. (2022) · Revista Española de Cardiología · doi:10.1016/j.recesp.2021.10.016 · Cited by 80 · see citing works
Blood Pressure Management in Stroke
Gorelick, P. B., Whelton, P. K., Sorond, F., & Carey, R. M. (2020) · Hypertension · doi:10.1161/hypertensionaha.120.14653 · Cited by 73 · see citing works
Guidelines on the management of arterial hypertension and related comorbidities in Latin America
Task Force of the Latin American Society of Hypertension (2017) · Journal of Hypertension · doi:10.1097/hjh.0000000000001418 · Cited by 72 · see citing works
Guía práctica sobre el diagnóstico y tratamiento de la hipertensión arterial en España, 2022. Sociedad Española de Hipertensión - Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA)
Gorostidi, M., Gijón‐Conde, T., Sierra, À., Rodilla, E., Rubio, E., Vinyoles, E., Oliveras, A., Santamaría, R., Segura, J., Molinero, A., et al. (2022) · Hipertensión y Riesgo Vascular · doi:10.1016/j.hipert.2022.09.002 · Cited by 81 · see citing works
Epidemiology and Primary Prevention of Stroke
Furie, K. L. (2020) · CONTINUUM Lifelong Learning in Neurology · doi:10.1212/con.0000000000000831 · Cited by 70 · see citing works
Combination drug treatment in hypertension
Tsioufis, C. P., & Thomopoulos, C. (2017) · Pharmacological Research · doi:10.1016/j.phrs.2017.09.011 · Cited by 62 · see citing works
Self-citation
Sex differences in the renin-angiotensin-aldosterone system and its roles in hypertension, cardiovascular, and kidney diseases
Nwia, S. M., Leite, A. P. D. O., Li, X. C., & Zhuo, J. L. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1198090 · Cited by 59 · see citing works
Blood pressure targets in adults with hypertension
Arguedas, J. A., Leiva, V., & Wright, J. M. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004349.pub3 · Cited by 57 · see citing works
“More drugs and higher doses will also increase adverse drug eMects and could lead to higher rates of permanent treatment discontinuation (Thomopoulos 2016 b).”
BackgroundResultInfluential
Blood pressure control in hypertension. Pros and cons of available treatment strategies
Mancia, G., Rea, F., Cuspidi, C., Grassi, G. M., & Corrao, G. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000001181 · Cited by 53 · see citing works
Kinematics of the Spine Under Healthy and Degenerative Conditions: A Systematic Review
Widmer, J., Fornaciari, P. A., Senteler, M., Roth, T. A., Snedeker, J. G., & Farshad, M. (2019) · Annals of Biomedical Engineering · doi:10.1007/s10439-019-02252-x · Cited by 53 · see citing works
Aspirin for the Primary Prevention of Cardiovascular Disease: Time for a Platelet-Guided Approach
Cofer, L. B., Barrett, T. J., & Berger, J. S. (2022) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/atvbaha.122.318020 · Cited by 52 · see citing works
2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure
Casey, D. E., Thomas, R. J., Bhalla, V., Commodore-Mensah, Y. Y., Heidenreich, P. A., Kolte, D. S., Muntner, P., Smith, S. C., Spertus, J. A., Windle, J. R., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.10.001 · Cited by 48 · see citing works
Benefit-harm trade-offs of intensive blood pressure control versus standard blood pressure control on cardiovascular and renal outcomes: an individual participant data analysis of randomised controlled trials.
Guo, X.-F., Sun, G.-Z., Xu, Y., Zhou, S., Song, Q.-R., Li, Y., Ouyang, N.-X., Li, G.-X., Cheng, Z.-D., Ye, N., et al. (2025) · The Lancet · doi:10.1016/s0140-6736(25)01391-1 · Cited by 30 · see citing works
SPRINT Blood Pressure
Parati, G., Ochoa, J. E., Bilo, G., & Zanchetti, A. (2016) · Hypertension · doi:10.1161/hypertensionaha.116.08216 · Cited by 47 · see citing works
Self-citation
Documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) sobre las guías ACC/AHA 2017 de hipertensión arterial
Gijón‐Conde, T., Gorostidi, M., Camafort, M., Abad-Cardiel, M., Martín-Rioboó, E., Morales‐Olivas, F. J., Vinyoles, E., Armario, P., Banegas, J. R., Coca, A., et al. (2018) · Hipertensión y Riesgo Vascular · doi:10.1016/j.hipert.2018.04.001 · Cited by 46 · see citing works
Telomere Length: A Potential Biomarker for the Risk and Prognosis of Stroke
Tian, Y., Wang, S., Jiao, F., Kong, Q., Liu, C., & Wu, Y. (2019) · Frontiers in Neurology · doi:10.3389/fneur.2019.00624 · Cited by 45 · see citing works
Implications of Recent Clinical Trials and Hypertension Guidelines on Stroke and Future Cerebrovascular Research
Lackland, D. T., Carey, R. M., Conforto, A. B., Rosendorff, C., Whelton, P. K., & Gorelick, P. B. (2018) · Stroke · doi:10.1161/strokeaha.117.019379 · Cited by 44 · see citing works
2018 Korean society of hypertension guidelines for the management of hypertension: part III-hypertension in special situations
Kim, K., Ihm, S., Kim, G., Kim, H. C., Kim, J. H., Lee, H., Lee, J. H., Park, J. M., Park, S., Pyun, W. B., et al. (2019) · Clinical Hypertension · doi:10.1186/s40885-019-0123-y · Cited by 44 · see citing works
Magnitude of Hypotension Based on Office and Ambulatory Blood Pressure Monitoring: Results From a Cohort of 5066 Treated Hypertensive Patients Aged 80 Years and Older
Divisón, J. A., Ruilope, L. M., de la Sierra, A., de la Cruz, J. J., Vinyoles, E., Gorostidi, M., Escobar-Cervantes, C., Velilla-Zancada, S. M., Segura, J., & Banegas, J. R. (2017) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.01.015 · Cited by 43 · see citing works
Optimal blood pressure targets for patients with hypertension: a systematic review and meta-analysis
Sakima, A., Satonaka, H., Nishida, N., Yatsu, K., & Arima, H. (2019) · Hypertension Research · doi:10.1038/s41440-018-0123-4 · Cited by 42 · see citing works
RSSDI-ESI Clinical Practice Recommendations for the Management of Type 2 Diabetes Mellitus 2020
Chawla, R., Madhu, S. V., Makkar, B. M., Ghosh, S. K., Saboo, B., Kalra, S., & On behalf of RSSDI-ESI Consensus Group (2020) · International Journal of Diabetes in Developing Countries · doi:10.1007/s13410-020-00819-2 · Cited by 43 · see citing works
Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF
Kandzari, D. E., Townsend, R. R., Bakris, G. L., Basile, J., Bloch, M. J., Cohen, D. L., East, C. A., Ferdinand, K. C., Fisher, N. D. L., Kirtane, A. J., et al. (2021) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.29884 · Cited by 40 · see citing works
Ideal Target Blood Pressure in Hypertension
Park, S. (2019) · Korean Circulation Journal · doi:10.4070/kcj.2019.0261 · Cited by 39 · see citing works
DASH vs. Mediterranean diet on a salt restriction background in adults with high normal blood pressure or grade 1 hypertension: A randomized controlled trial
Filippou, C. D., Thomopoulos, C., Konstantinidis, D., Siafi, E. P., Tatakis, F., Manta, E., Drogkaris, S., Polyzos, D., Kyriazopoulos, K., Grigoriou, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.08.011 · Cited by 37 · see citing works
Self-citation
Cardiovascular outcome in treatment-resistant hypertension
Holmqvist, L. D., Boström, K. B., Kahan, T., Schiöler, L., Hasselström, J., Hjerpe, P., Wettermark, B., & Manhem, K. (2017) · Journal of Hypertension · doi:10.1097/hjh.0000000000001561 · Cited by 34 · see citing works
Executive summary of the 2020 clinical practice guidelines for the management of hypertension in the Philippines
Ona, D. I. D., Jimeno, C., Jasul, G., Bunyi, M. L., Oliva, R., Santos, L. E. G., MERCADO-ASIS, L. B., Luz, V. A., Leus, A., Diaz, A. F., et al. (2021) · Journal of Clinical Hypertension · doi:10.1111/jch.14335 · Cited by 35 · see citing works
National Clinical Guidelines
(2017) · The American Pharmacists Association eBooks · doi:10.21019/9781582122885.nationalclinicalguidelines · Cited by 32 · see citing works
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 · see citing works
“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.”
ResultInfluential
Status of hypertension in Europe
Reuter, H., & Jordan, J. (2019) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000642 · Cited by 31 · see citing works
Revisiting Cardiovascular Benefits of Blood Pressure Reduction in Primary and Secondary Prevention: Focus on Targets and Residual Risk—A Systematic Review and Meta-Analysis
Manta, E., Thomopoulos, C., Kariori, M. G., Polyzos, D., Mihas, C. C., Konstantinidis, D., Farmakis, D. T., Mancia, G., & Tsioufis, K. P. (2024) · Hypertension · doi:10.1161/hypertensionaha.123.22610 · Cited by 30 · see citing works
“22,23 Most importantly, on-treatment variables, such as BP targets, can only be evaluated by aggregate data meta-analyses because the network or individual patient data meta-analyses, statistical methods that have been used previously, do not preserve randomization.”
Self-citation
Status of Hypertension in Tehran: Potential impact of the ACC/AHA 2017 and JNC7 Guidelines, 2012–2015
Asgari, S., Khaloo, P., Khalili, D., Azizi, F., & Hadaegh, F. (2019) · Scientific Reports · doi:10.1038/s41598-019-42809-3 · Cited by 30 · see citing works

Effects of blood pressure lowering on outcome incidence in hypertension. 1. Overview, meta-analyses, and meta-regression analyses of randomized trials
Thomopoulos, C., Parati, G., & Zanchetti, A. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000378 · Cited by 388 · see citing works
Self-citation
Abstract FR449: Intensive Systolic Blood Pressure Lowering Reduces Major Cardiovascular Events: A Meta-Analysis of 83,580 Patients
Nawab, J., Sarker, S., Banerjee, S., Herazo, C. A. B., Afra, M., Rayudu, U. S., Abdel-Khalik, A. S., Patel, R., Bucataru, L., Khizer, U., et al. (2025) · Hypertension · doi:10.1161/hyp.82.suppl_1.fr449
More Versus Less Blood Pressure Lowering: An Update
Atkins, E. R., & Rodgers, A. (2016) · Clinical Therapeutics · doi:10.1016/j.clinthera.2016.08.007 · Cited by 12 · see citing works
Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: a systematic review and meta-analysis. PLoS Med 9(8):e1001293
Lv, J., Neal, B., Ehteshami, P., Ninomiya, T., Woodward, M., Rodgers, A., Wang, H., Macmahon, S. W., Turnbull, F., Hillis, G., et al. (2012)
Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis
Xie, X., Atkins, E., Lv, J., Bennett, A., Neal, B., Ninomiya, T., Woodward, M., MacMahon, S., Turnbull, F., Hillis, G. S., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(15)00805-3 · Cited by 980 · see citing works

Authors: Thomopoulos, C., Parati, G., & Zanchetti, A.
Affiliations: University of Milan (IT)
Corresponding author: Zanchetti, Alberto
ORCID: Thomopoulos, Costas
Parati, Gianfranco
Zanchetti, Alberto
Venue: Journal of Hypertension
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2016-04
Volume: 34
Issue: 4
Pages: 613-622
ISSN: 0263-6352 (ISSN-L)
DOI: 10.1097/hjh.0000000000000881
OpenAlex: W2330187990
Cited by: 298
References: 62
Citations by year: 2026: 6 · 2025: 19 · 2024: 14 · 2023: 21 · 2022: 28 · 2021: 26 · 2020: 36 · 2019: 44 · 2018: 41 · 2017: 35 · 2016: 28
FWCI: 8.71
Type: journal article
Language: en
Open access: closed
Locations: Journal of Hypertension (publishedVersion)
PubMed (publishedVersion)
BOA (University of Milano-Bicocca) (submittedVersion)
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: hypertension, blood pressure reduction, blood pressure targets, cardiovascular mortality, stroke, coronary events, major adverse cardiovascular events, heart failure, all-cause mortality, residual cardiovascular risk, SPRINT trial, absolute risk reduction, relative risk reduction, standardized mean difference
MeSH terms: Antihypertensive Agents, Blood Pressure, Humans, Hypertension, Incidence, Treatment Outcome

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Effects of blood pressure lowering on outcome incidence in hypertension: 7. Effects of more vs. less intensive blood pressure lowering and different achieved blood pressure levels – updated overview and meta-analyses of randomized trials

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