Benefits of more intensive versus less intensive blood pressure control. Updated trial sequential analysis

Reboldi, Gianpaolo; Angeli, Fabio; Gentile, Giorgio; Verdecchia, Paolo

doi:10.1016/j.ejim.2022.03.032

Cited by 10 publications

(8 citation statements)

References 65 publications

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“…HTN means an elevation of blood pressure where systolic blood pressure increases over 140 mmHg and/or diastolic blood pressure (DBP) increases over 90 mmHg at rest ( Kurl et al, 2021 ). Globally, HTN continues to be a major risk factor for cardiovascular disease and mortality ( Reboldi et al, 2022 ). HTN is often called the silent killer because it is asymptomatic in many cases and symptoms are difficult to detect without special apparatus, causing around 9.4 million deaths worldwide ( Kalehoff & Oparil, 2020 ; Sayyad et al, 2021 ).…”

Section: Review Of Literaturementioning

confidence: 99%

Knowledge, Attitudes, and Practices of Hypertensive Patients Towards Stroke Prevention Among Rural Population in Saudi Arabia: A Cross-Sectional Study

et al. 2023

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Introduction Stroke is a significant health problem and is considered one of the leading causes of mortality and permanent disability worldwide. Hypertension is a primary risk factor for stroke. Thus, hypertensive patients’ knowledge, attitudes, and practices (KAP) are essential in preventing stroke. Objective To examine hypertensive patients’ KAP towards stroke prevention among rural population in Saudi Arabia. Methods The study utilized a cross-sectional design. The data were collected using a convenience sampling technique from hypertensive patients in the northwestern rural areas of Riyadh Province. A self-administered questionnaire was adapted from the Stroke Recognition Questionnaire (SRQ) and utilized to assess KAP towards stroke prevention among rural hypertensive patients. The STrengthening of the Reporting of OBservational studies in Epidemiology (STROBE) checklist was used to report the study. Results A total of 196 hypertensive patients participated in the study. The total mean scores categorization into three quartiles showed that most respondents had poor levels of KAP towards stroke prevention. Weak positive correlations were found between KAP of patients. There were statistically significant differences between respondents’ attitudes and practices with their age, education, marital status, and occupational status. Discussion This study denoted poor levels of KAP towards stroke prevention among hypertensive patients living in rural areas. This study showed the importance of further considering rural population by which improving their health and quality of life. Extending health educational programs and behavior-changing strategies to rural areas is essential to increase hypertensive patients and general public awareness about their stroke prevention and other health-related concerns.

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Section: Review Of Literaturementioning

confidence: 99%

Knowledge, Attitudes, and Practices of Hypertensive Patients Towards Stroke Prevention Among Rural Population in Saudi Arabia: A Cross-Sectional Study

et al. 2023

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“…Hence, our efforts should pragmatically prioritize the prevention of CV events rather than the prevention of ESRD in CKD patients, and the adoption of a pragmatical target BP should never neglect this unquestionable reality. To ascertain the benefits of more versus less intensive BP control, we recently published an updated trial sequential analysis on 16 randomised controlled trials which compared different BP targets and reported specific CV outcomes, including CV death, myocardial infarction, stroke and heart failure [ 90 ]. Our trial sequential analysis aimed at estimating whether the evidence progressively accrued on the aforementioned outcomes can be considered strong and conclusive; the logic of “early stopping rules” used during randomised controlled trials to establish whether it is still ethical to continue the study on the basis of data accrued thus far can be applied to the trial sequential analysis to understand if the accrued data are conclusive and no further randomised controlled studies are needed [ 91 , 92 ].…”

Section: Discussionmentioning

confidence: 99%

Tight Blood Pressure Control in Chronic Kidney Disease

Gentile

Mckinney

Reboldi

2022

JCDD

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Hypertension affects over a billion people worldwide and is the leading cause of cardiovascular disease and premature death worldwide, as well as one of the key determinants of chronic kidney disease worldwide. People with chronic kidney disease and hypertension are at very high risk of renal outcomes, including progression to end-stage renal disease, and, even more importantly, cardiovascular outcomes. Hence, blood pressure control is crucial in reducing the human and socio-economic burden of renal and cardiovascular outcomes in those patients. However, current guidelines from hypertension and renal societies have issued different and sometimes conflicting recommendations, which risk confusing clinicians and potentially contributing to a less effective prevention of renal and cardiovascular outcomes. In this review, we critically appraise existing evidence and key international guidelines, and we finally formulate our own opinion that clinicians should aim for a blood pressure target lower than 130/80 in all patients with chronic kidney disease and hypertension, unless they are frail or with multiple comorbidities. We also advocate for an even more ambitious systolic blood pressure target lower than 120 mmHg in younger patients with a lower burden of comorbidities, to minimise their risk of renal and cardiovascular events during their lifetime.

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“…The achieved systolic BP was 7.7 mm Hg lower with the more intensive than the less intensive control strategy. 8 Compared with the less intensive strategy, the more intensive strategy significantly reduced stroke by 21%, myocardial infarction by 19%, heart failure by 27%, and cardiovascular death by 19%. 8 However, the predefined BP targets in randomized strategy trials were extremely heterogeneous.…”

Section: See Related Article Pp 1640-1653mentioning

confidence: 96%

“…8 Compared with the less intensive strategy, the more intensive strategy significantly reduced stroke by 21%, myocardial infarction by 19%, heart failure by 27%, and cardiovascular death by 19%. 8 However, the predefined BP targets in randomized strategy trials were extremely heterogeneous. In some studies, the strategy was based on systolic BP, in other studies on diastolic BP, in other studies on a combination of systolic and diastolic BP, in others on mean BP.…”

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confidence: 96%

“…We recently completed an updated trial sequential analysis of studies, published between 1998 and 2021, designed to compare more intensive versus less intensive BP control strategies, for a total of 60 870 randomized patients, and an average duration of follow-up of 3.9 years. 8 The examined studies included patients with and without type 2 diabetes. The achieved systolic BP was 7.7 mm Hg lower with the more intensive than the less intensive control strategy.…”

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confidence: 99%

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It Is Time to Reconsider the Blood Pressure Targets in Patients With Type 2 Diabetes?

Verdecchia¹,

Reboldi

Angeli

2023

Hypertension

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Benefits of more intensive versus less intensive blood pressure control. Updated trial sequential analysis

Cited by 10 publications

References 65 publications

Knowledge, Attitudes, and Practices of Hypertensive Patients Towards Stroke Prevention Among Rural Population in Saudi Arabia: A Cross-Sectional Study

Knowledge, Attitudes, and Practices of Hypertensive Patients Towards Stroke Prevention Among Rural Population in Saudi Arabia: A Cross-Sectional Study

Tight Blood Pressure Control in Chronic Kidney Disease

It Is Time to Reconsider the Blood Pressure Targets in Patients With Type 2 Diabetes?

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