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Effects of blood pressure lowering on outcome incidence in hypertension: 2. Effects at different baseline and achieved blood pressure levels--overview and meta-analyses of randomized trials.
J Hypertens 2014; 32(12):2296-304JH

Abstract

BACKGROUND

Relevant clinical questions not approached by randomized controlled trials (RCTs) of blood pressure (BP)-lowering treatment can be explored by meta-analyses stratified by clinical criteria.

OBJECTIVES

Investigating whether all grades of hypertension benefit from BP-lowering treatment and which are the target BP levels to maximize outcome reduction.

METHODS

Of the 68 RCTs of intentional and nonintentional BP-lowering, those without baseline antihypertensive drugs were stratified by the average baseline SBP and DBP (hypertension grades 1, 2, and 3). RCTs with or without baseline treatment were considered for investigating the effects of mean achieved SBP/DBP across three SBP cutoffs and two DBP cutoffs. Risk ratios (RR) and 95% confidence interval (CI) (random-effects model), standardized to 10/5 mmHg SBP/DBP reduction, and absolute risk reductions of seven fatal and nonfatal outcomes were calculated. Differences between relative and absolute risk reductions in the different strata of baseline or achieved SBP/DBP were evaluated by trend or heterogeneity analyses.

RESULTS

In 32 RCTs (104,359 individuals), significant outcome reductions were found independently of the hypertension grade, with no trend toward risk ratio changes with increasing baseline BP. A secondary analysis limited to RCTs on grade 1 hypertension at low-to-moderate risk showed significant outcome reductions [risk ratio: stroke 0.33 (0.11-0.98), coronary events 0.68 (0.48-0.95), and death 0.53 (0.35-0.80)]. In 32 RCTs (128,232 individuals), relative and absolute outcome reductions were significant for the SBP differences across 150 and 140 mmHg cutoffs. Below 130 mmHg, only stroke and all-cause death were significantly reduced. Absolute outcome reduction showed a significant trend to decrease, the lower the SBP cutoff considered. In 29 RCTs (107,665 individuals), outcomes were significantly reduced across DBP cutoffs of 90 and 80 mmHg. After excluding RCTs with baseline DBP less than 90 mmHg, only stroke reduction was significant at achieved DBP less than 80 mmHg.

CONCLUSION

Meta-analyses favor BP-lowering treatment even in grade 1 hypertension at low-to-moderate risk, and lowering SBP/DBP to less than 140/90 mmHg. Achieving less than 130/80 mmHg appears safe, but only adds further reduction in stroke.

Authors+Show Affiliations

aDepartment of Cardiology, Helena Venizelou Hospital, Athens, Greece bDepartment of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS cDepartment of Health Sciences, University of Milan Bicocca dScientific Direction, Istituto Auxologico Italiano IRCCS eCentro Interuniversitario di Fisiologia Clinica e Ipertensione, University of Milan, Milan, Italy.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

25259547

Citation

Thomopoulos, Costas, et al. "Effects of Blood Pressure Lowering On Outcome Incidence in Hypertension: 2. Effects at Different Baseline and Achieved Blood Pressure Levels--overview and Meta-analyses of Randomized Trials." Journal of Hypertension, vol. 32, no. 12, 2014, pp. 2296-304.
Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 2. Effects at different baseline and achieved blood pressure levels--overview and meta-analyses of randomized trials. J Hypertens. 2014;32(12):2296-304.
Thomopoulos, C., Parati, G., & Zanchetti, A. (2014). Effects of blood pressure lowering on outcome incidence in hypertension: 2. Effects at different baseline and achieved blood pressure levels--overview and meta-analyses of randomized trials. Journal of Hypertension, 32(12), pp. 2296-304. doi:10.1097/HJH.0000000000000379.
Thomopoulos C, Parati G, Zanchetti A. Effects of Blood Pressure Lowering On Outcome Incidence in Hypertension: 2. Effects at Different Baseline and Achieved Blood Pressure Levels--overview and Meta-analyses of Randomized Trials. J Hypertens. 2014;32(12):2296-304. PubMed PMID: 25259547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of blood pressure lowering on outcome incidence in hypertension: 2. Effects at different baseline and achieved blood pressure levels--overview and meta-analyses of randomized trials. AU - Thomopoulos,Costas, AU - Parati,Gianfranco, AU - Zanchetti,Alberto, PY - 2014/9/27/entrez PY - 2014/9/27/pubmed PY - 2016/3/29/medline SP - 2296 EP - 304 JF - Journal of hypertension JO - J. Hypertens. VL - 32 IS - 12 N2 - BACKGROUND: Relevant clinical questions not approached by randomized controlled trials (RCTs) of blood pressure (BP)-lowering treatment can be explored by meta-analyses stratified by clinical criteria. OBJECTIVES: Investigating whether all grades of hypertension benefit from BP-lowering treatment and which are the target BP levels to maximize outcome reduction. METHODS: Of the 68 RCTs of intentional and nonintentional BP-lowering, those without baseline antihypertensive drugs were stratified by the average baseline SBP and DBP (hypertension grades 1, 2, and 3). RCTs with or without baseline treatment were considered for investigating the effects of mean achieved SBP/DBP across three SBP cutoffs and two DBP cutoffs. Risk ratios (RR) and 95% confidence interval (CI) (random-effects model), standardized to 10/5 mmHg SBP/DBP reduction, and absolute risk reductions of seven fatal and nonfatal outcomes were calculated. Differences between relative and absolute risk reductions in the different strata of baseline or achieved SBP/DBP were evaluated by trend or heterogeneity analyses. RESULTS: In 32 RCTs (104,359 individuals), significant outcome reductions were found independently of the hypertension grade, with no trend toward risk ratio changes with increasing baseline BP. A secondary analysis limited to RCTs on grade 1 hypertension at low-to-moderate risk showed significant outcome reductions [risk ratio: stroke 0.33 (0.11-0.98), coronary events 0.68 (0.48-0.95), and death 0.53 (0.35-0.80)]. In 32 RCTs (128,232 individuals), relative and absolute outcome reductions were significant for the SBP differences across 150 and 140 mmHg cutoffs. Below 130 mmHg, only stroke and all-cause death were significantly reduced. Absolute outcome reduction showed a significant trend to decrease, the lower the SBP cutoff considered. In 29 RCTs (107,665 individuals), outcomes were significantly reduced across DBP cutoffs of 90 and 80 mmHg. After excluding RCTs with baseline DBP less than 90 mmHg, only stroke reduction was significant at achieved DBP less than 80 mmHg. CONCLUSION: Meta-analyses favor BP-lowering treatment even in grade 1 hypertension at low-to-moderate risk, and lowering SBP/DBP to less than 140/90 mmHg. Achieving less than 130/80 mmHg appears safe, but only adds further reduction in stroke. SN - 1473-5598 UR - https://www.unboundmedicine.com/medline/citation/25259547/Effects_of_blood_pressure_lowering_on_outcome_incidence_in_hypertension:_2__Effects_at_different_baseline_and_achieved_blood_pressure_levels__overview_and_meta_analyses_of_randomized_trials_ L2 - http://dx.doi.org/10.1097/HJH.0000000000000379 DB - PRIME DP - Unbound Medicine ER -