Intensive versus Usual Control of Hypertension in the Prevention of Cardiovascular and Renal Outcomes: A Cumulative Meta-Analysis of Randomized Controlled Trials

Li, Li; Li, Ling

doi:10.1159/000499009

Cited by 4 publications

(1 citation statement)

References 44 publications

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“…A number of systematic reviews and meta-analyses have also been conducted in the topic area and have generally reported greater vascular protection with intensive BP control, but these were not based in older patients 65 years, and their control arms included standard BP control and placebo. 31,32 In attempting to synthesise the sparse data on the harms and benefits of intensive BP control on older hypertensive patients with DM, we have demonstrated major evidence gaps and the urgent need for the conduct of larger definitive trials in this area. The overall findings provide clear evidence on the benefits of intensive BP control in older hypertensive patients using an SBP threshold of <120 to <140 mmHg, which are consistent with recommendations from some guideline bodies.…”

Section: General Populationmentioning

confidence: 99%

Intensive versus standard blood pressure control in older persons with or without diabetes: a systematic review and meta-analysis of randomised controlled trials

et al. 2023

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Objectives To assess and compare the benefits and harms of intensive versus standard blood pressure (BP) control in older people with or without diabetes mellitus (DM). Design Systematic review and meta-analysis Setting Randomised controlled trials comparing intensive versus standard BP control, identified from MEDLINE, Embase, The Cochrane library, Web of Science and a search of bibliographies from inception till August 2022. Participants Older people (≥65 years) with or without DM. Main outcome measures Study-specific risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for adverse vascular and safety outcomes. Results We included six randomised controlled trials (RCTs) comprising 20,985 patients (intensive BP = 10,474 and standard BP = 10,511) with a weighted mean follow-up of 3.1 years. In the general population, the RRs (95% CIs) of intensive versus standard BP control for composite cardiovascular events or major adverse cardiovascular events (CVD/MACE), CVD mortality, coronary heart disease, stroke and heart failure were 0.71 (0.62–0.82), 0.65 (0.49–0.86), 0.75 (0.60–0.95), 0.75 (0.61–0.92) and 0.58 (0.41–0.82), respectively. Intensive BP control did not increase the risk of renal failure or serious adverse events in the general population. Two RCTs reported results for composite CVD/MACE in patients with DM with a pooled estimate of 0.85 (0.67–1.07). Conclusions Aggregate trial evidence shows that intensive BP control (<120 to <140 mmHg) reduces the risk of adverse cardiovascular outcomes in older hypertensive patients in the general population with no increase in adverse events. Intensive BP control may confer similar benefits for older patients with DM with no evidence for harm, but this is based on limited data. PROSPERO Registration: CRD42022349791

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Section: General Populationmentioning

confidence: 99%

Intensive versus standard blood pressure control in older persons with or without diabetes: a systematic review and meta-analysis of randomised controlled trials

et al. 2023

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Blood pressure control in older adults with hypertension: A systematic review with meta-analysis and meta-regression

Baffour-Awuah

Dieberg

Pearson

et al. 2020

International Journal of Cardiology Hypertension

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Intensive Blood Pressure Treatment Goals: Evidence for Cardiovascular Protection From Observational Studies and Clinical Trials

Bundy

Carey

2022

American Journal of Hypertension

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Epidemiologic studies have consistently identified a strong, progressive relationship between blood pressure and cardiovascular disease events, in a range of systolic blood pressure (SBP) from as low as 90 mm Hg to as high as 180 mm Hg. Clinical trials have demonstrated greater prevention of cardiovascular disease with more compared to less intensive antihypertensive drug treatment. Meta-analyses of randomized controlled trials provides strong evidence for more intensive antihypertensive drug therapy down to an SBP of 130 mm Hg, and to an SBP 120-124 mm Hg in the meta-analysis with the greatest statistical power. In the Systolic Blood Pressure Intervention Trial (SPRINT) randomization to an SBP treatment goal of <120 mm Hg compared to <140 mm Hg in persons with high cardiovascular disease risk not only reduced the rate of cardiovascular disease but also all-cause mortality. These benefits were noted in all of the pre-stated subgroups of interest, including those ≥65 years of age at baseline. In addition, cognitive impairment was less common in those randomized to the intensive compared to standard treatment. Most clinical practice guidelines recommend an SBP treatment target <130 mm Hg in adults with a high risk of CVD, which is the norm for many patients seen in clinical practice, especially those who are older, have diabetes mellitus, or chronic kidney disease.

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Intensive versus Usual Control of Hypertension in the Prevention of Cardiovascular and Renal Outcomes: A Cumulative Meta-Analysis of Randomized Controlled Trials

Cited by 4 publications

References 44 publications

Intensive versus standard blood pressure control in older persons with or without diabetes: a systematic review and meta-analysis of randomised controlled trials

Intensive versus standard blood pressure control in older persons with or without diabetes: a systematic review and meta-analysis of randomised controlled trials

Blood pressure control in older adults with hypertension: A systematic review with meta-analysis and meta-regression

Intensive Blood Pressure Treatment Goals: Evidence for Cardiovascular Protection From Observational Studies and Clinical Trials

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