Intense blood pressure control cuts cardiovascular risk, researchers find

Reducing the systolic blood pressure (SBP) of people with hypertension to below currently recommended targets reduces the risk of cardiovascular disease and death, according to the findings of a systematic review.

The meta-analysis found that the lowest risk of these outcomes was seen in people with a treated SBP of 120–124mmHg. By contrast, current guidance from the UK’s National Institute for Health and Care Excellence is to target an SBP of 140mmHg in people under 80 years old.

The findings, published in JAMA Cardiology
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(online, 31 May 2017), were based on data from 42 randomised trials, where people were assigned to either an antihypertensive treatment, control or a blood pressure target, and included a total of 144,220 patients. 

The researchers, led by Jiang He at the Tulane University School of Public Health and Tropical Medicine in Louisiana, found a linear relationship between SBP and cardiovascular disease and all-cause mortality.

When they compared those with a mean achieved SBP of 120–124mmHg with other groups, these people had a 29% reduced risk of cardiovascular disease versus those who achieved a mean SBP of 130–134mmHg, a 42% reduced risk compared to the 140–144mm Hg group and a 64% reduced risk compared with those whose mean SBP was 160mm Hg or above. 

The results were similar when the team look at all-cause mortality where those achieving a mean SBP of 120–124mmHg had a 41% reduced risk compared with those in the 140–144mmHg group, and a 53% reduced risk compared with those whose SBP was 160mmHg or above. 

The findings support the conclusions of the SPRINT trial which endorsed intensive blood pressure reduction through antihypertensive treatment, and do not suggest a J-shaped relationship between SBP and outcomes, as some studies have found, the researchers say. 

“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,” they conclude.