Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis

Xie, Xinfang; Atkins, Emily; Lv, Jicheng; Bennett, Alexander; Neal, Bruce; Ninomiya, Toshiharu; Woodward, Mark; MacMahon, Stephen; Turnbull, Fiona; Hillis, Graham S.; Chalmers, John; Mant, Jonathan; Salam, Abdul; Rahimi, Kazem; Perkovic, Vlado; Rodgers, Anthony

doi:10.1016/s0140-6736(15)00805-3

Cited by 861 publications

(569 citation statements)

References 41 publications

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“…In addition, there is little guidance on how to interpret the 2017 ACC/AHA clinical guidelines on hypertension as they apply to pregnancy. The 2017 ACC/AHA guidelines stemmed from recent clinical trials that have demonstrated that achieving intensive BP reduction (systolic BP <120 mm Hg) resulted in a significant decrease in the risk of CVD events and mortality compared with BP reduction to within the range currently termed stage 1 hypertension (systolic BP 130–139 mm Hg or diastolic BP 80–89 mm Hg) 66, 67, 68. The threshold for BP treatment in pregnancy is higher, generally above systolic BP 150 to 160 mm Hg and diastolic BP 95 to 110 mm Hg.…”

Section: Current Guidelines and Recommendationsmentioning

confidence: 99%

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

Ying

Catov

Ouyang

2018

JAHA

187

119

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Section: Current Guidelines and Recommendationsmentioning

confidence: 99%

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

Ying

Catov

Ouyang

2018

JAHA

187

119

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“…A recent systematic review and meta‐analysis of 19 trials suggested that intensive blood pressure lowering, including targeting SBP/DBP lower than current recommendations, has further protective effects against major cardiovascular events 14. The recent Systolic Blood Pressure Intervention Trial (SPRINT) showed that with treatment targeting an SBP of less than 120 mm Hg compared with 140 mm Hg, nondiabetic adults aged 50 and above at high risk for cardiovascular events had lower rates of all‐cause mortality and major cardiovascular events15; in prespecified subgroup analysis, this benefit was similarly observed among those aged 75 years or older 16.…”

Section: Introductionmentioning

confidence: 99%

Treatment Intensification for Hypertension in US Ambulatory Medical Care

Lin

Mukamal

2016

JAHA

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BackgroundHypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all‐cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care.Methods and ResultsUsing the nationally representative National Ambulatory Medical Care Survey (2005–2012) and National Hospital Ambulatory Medical Care Survey (2005–2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005–2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2–7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time.ConclusionsUS hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension‐related morbidity and mortality nationwide.

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“…Beginning in the 1960s, randomized controlled trials demonstrated the value of treating high diastolic blood pressure and, subsequently, high systolic blood pressure (SBP) 1, 2. However, the treatment target for SBP has been uncertain 3, 4.…”

mentioning

confidence: 99%

“…However, the treatment target for SBP has been uncertain 3, 4. Several recent meta‐analyses support “intensive” SBP lowering in patients with and without diabetes mellitus, but these included randomized controlled trials that targeted a higher SBP goal (<140 mm Hg or even higher) for “intensive” SBP control or blood pressure medication trials that did not have a predefined SBP goal 2, 5, 6, 7. The recent American College of Cardiology/American Heart Association guidelines recommend an SBP goal of <130 mm Hg in patients with and without diabetes mellitus 8…”

mentioning

confidence: 99%

Effects of Intensive Systolic Blood Pressure Lowering on Cardiovascular Events and Mortality in Patients With Type 2 Diabetes Mellitus on Standard Glycemic Control and in Those Without Diabetes Mellitus: Reconciling Results From ACCORD BP and SPRINT

Beddhu

Chertow

Greene

et al. 2018

JAHA

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BackgroundIntensive systolic blood pressure (SBP) lowering significantly reduced cardiovascular disease (CVD) events in SPRINT (Systolic Blood Pressure Intervention Trial) but not in ACCORD BP (Action to Control Cardiovascular Risk in Diabetes Blood Pressure).Methods and Results SPRINT tested the effects of intensive (<120 mm Hg) versus standard (<140 mm Hg) SBP goals on CVD events and all‐cause mortality. Using 2×2 factorial design, ACCORD BP tested the same SBP intervention in addition to an intensive versus standard glycemia intervention. We compared the effects of intensive SBP lowering on the composite CVD end point and all‐cause mortality in SPRINT with its effects within each of the glycemia arms in ACCORD BP. Intensive SBP lowering decreased the hazard of the composite CVD end point similarly in SPRINT (hazard ratio: 0.75; 95% confidence interval, 0.64–0.89) and in the ACCORD BP standard glycemia arm (hazard ratio: 0.77; 95% confidence interval, 0.63–0.95; interaction P=0.87). However, the effect of intensive SBP lowering on the composite CVD end point in the ACCORD BP intensive glycemia arm (hazard ratio: 1.04; 95% confidence interval, 0.83–1.29) was significantly different from SPRINT (interaction P=0.023). Patterns were similar for all‐cause mortality.ConclusionsThe effects of intensive SBP control on CVD events and all‐cause mortality were similar in patients without diabetes mellitus and in those with diabetes mellitus on standard glycemic control. An interaction between intensive SBP lowering and intensive glycemic control may have masked beneficial effects of intensive SBP lowering in ACCORD BP.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01206062, NCT00000620.

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Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis

Abstract: National Health and Medical Research Council of Australia.

Cited by 861 publications

References 41 publications

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

Hypertensive Disorders of Pregnancy and Future Maternal Cardiovascular Risk

Treatment Intensification for Hypertension in US Ambulatory Medical Care

Effects of Intensive Systolic Blood Pressure Lowering on Cardiovascular Events and Mortality in Patients With Type 2 Diabetes Mellitus on Standard Glycemic Control and in Those Without Diabetes Mellitus: Reconciling Results From ACCORD BP and SPRINT

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