Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality A Systematic Review and Network Meta-analysis

This analysis of 42 RCTs reports that linear associations were seen between mean achieved systolic blood pressure and risk of cardiovascular disease and mortality, with the lowest risk at a systolic blood pressure of 120 to 124 mm Hg.

The researchers highlight several limitations, namely, sample size in some mean achieved systolic blood pressure (SBP) comparisons were small, few trials reported heart failure outcomes, and the association between intensive lowering of SBP with adverse outcomes such as hypotension, falling or kidney disease were not considered. Furthermore, subgroup analyses by age, race/ethnicity, history of CVD, stroke, chronic kidney disease, or diabetes were not evaluated.

 

The researchers conclude that these findings support more intensive SBP control among adults with hypertension and suggest the need for revising the current clinical guidelines for management of hypertension.

 

Current guidance from the National Institute for Health and Care Excellence is to target an SBP of 140mmHg in people under 80 years old.