What is the Optimal Blood Pressure Target When Treating Hypertension?
This study by Bangalore et al. (American Journal of Medicine, 2017) aimed to assess the optimal on-treatment blood pressure (BP) target.
Systemic Review and Meta-Analysis
This study analyzed 17 trials, including 55,163 patients and 204,103 patient-years of follow-up. The 5 target systolic BP groups were as follows: (1) <160 mm Hg; (2) <150 mm Hg; (3) <140 mm Hg; (4) <130 mm Hg; (5) <120 mm Hg. With a systolic BP of <120 mmHg vs. <150 mmHg there was a significant decrease in stroke (Relative risk 0.54; 95% CI, 0.29-1.00) and myocardial infarction (Relative Risk 0.68; 95% CI, 0.47-1.00). When compared to a BP of <120 mmHg, stroke increase was 72% (<140 mmHg), 97% (<150 mmHg), and 227% (<160 mmHg). No differences in death, cardiovascular death, or heart failure regardless of target group. However, there was a significant increase in adverse effects (for example angioedema, hypotension, syncope, bradycardia/arrhythmia) with BP <120 mmHg vs. <150 mmHg. The BP targets with the smallest risks of serious adverse effects were <140 mmHg and <150 mmHg. In summary, while the recent SPRINT trial found that a BP target of <120 mmHg showed significant benefits, it came with the risk of increased adverse effects. The authors suggest that a target BP of <130 mmHg was optimal, as it had the best balance between effectiveness and safety.
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