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Effects of Intensive BP Lowering

Meta-analysis looks at CV at renal outcomes

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More intensive blood pressure (BP) lowering provided greater protection against major cardiovascular events than standard regimens, especially for high-risk patients, according to a meta-analysis that included 19 trials in which 44,989 patients were randomized to more or less-intensive BP control. Nearly 2,500 major CV events were recorded during a mean 3.8 years follow-up and the analysis found:

• Patients in the more intensive BP-lowering treatment group had mean BP levels of 133/76 mmHg vs 140/81 mmHg in the less intensive treatment group.

• Intensive BP-lowering treatment achieved relative risk reductions for major CV events (RR=14%), including:

  • Myocardial infarction, 13%
  • Stroke, 22%
  • Albuminuria, 10%
  • Retinopathy progression, 19%

• More intensive treatment had no clear effects on heart failure, CV death, total mortality, or end-stage kidney disease.

• Reduction in major CV events was consistent across patient groups.

Citation: Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. [Published online ahead of print November 6, 2015]. Lancet. doi: 10.1016/S0140-6736(15)00805-3.

Commentary: This systematic review, showing a benefit of achieving systolic blood pressures near 130 mmHg compared to 140 mmHg, add to the emerging prospective trial evidence that blood pressures lower than a systolic of 140 may be advantageous to selected groups of patients. This article supports the results of the recent SPRINT trial which showed, in a high risk population, that a systolic blood pressure target of < 120 mmHg vs a target of < 140 mmHg led to significantly lower all-cause mortality (HR, 0.73) and a lower rate of the primary composite outcome (myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from CV causes) in the intensive-treatment group vs the standard-treatment group (HR, 0.75).1 While we await the input from guideline organizations, it appears that systolic blood pressures less than the traditional 140 mmHg may be beneficial, if able to be reasonably achieved, in selected groups of patients with hypertension. —Neil Skolnik, MD

1. Wright JT, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood-pressure control. [Published online ahead of print November 9, 2015]. N Engl J Med. doi: 10.1056/NEJMoa1511939.

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