What does this research mean for the field?

Randomized controlled trials do not demonstrate significant clinical benefit for lower blood pressure targets compared to standard targets, and overly aggressive therapy may cause potential harm. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 1, 2011Open Access

Goal-directed antihypertensive therapy: Lower may not always be better

Q: What is the clinical evidence from this study?

Study design: Review. Population: Hypertension. Intervention: Intensive blood pressure lowering (lower target) vs. Standard blood pressure lowering (higher target). Primary outcome: Cardiovascular and renal events.

Key Result

Randomized controlled trials have not shown a lower blood pressure target to offer significant clinical benefit over standard targets, and suggest potential harm with overly aggressive therapy.

Structured PICO

Does intensive blood pressure lowering to specific lower targets improve cardiovascular and renal outcomes in adults with hypertension compared to standard targets?

Population

Adults with hypertension, including those with chronic kidney disease, diabetes mellitus, or at high cardiovascular risk

Intervention

Intensive blood pressure lowering to specific lower targets (e.g., systolic <120 or <130 mm Hg, or lower mean arterial pressure)

Comparator

Standard or less intensive blood pressure targets (e.g., systolic <140 mm Hg, or higher mean arterial pressure)

Outcome

Cardiovascular morbidity and mortality, and progression of renal disease (decline in glomerular filtration rate or end-stage renal disease)composite

Targeting strict lower blood pressure goals does not consistently improve cardiovascular or renal outcomes and may increase adverse events, suggesting that individualized therapy is preferable to universal strict targets.

Limitations

Unblinded nature of the reviewed trials (most had a Jadad score of 3 out of 5)
Potential misclassification bias, such as masked hypertension outside the clinic
Strict inclusion and exclusion criteria in the trials may reduce external validity
Use of brachial rather than central aortic pressures to monitor blood pressure may not reflect true pressure burden

Abstract

At least 16 treatment trials have been done in which patients were randomly assigned different blood pressure goals in an attempt to better define specific target pressures. We critically review the data.

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Cite This Study

Filippone et al. (Tue,) conducted a review in Hypertension. Intensive blood pressure lowering (lower target) vs. Standard blood pressure lowering (higher target) was evaluated on Cardiovascular and renal events. Randomized controlled trials have not shown a lower blood pressure target to offer significant clinical benefit over standard targets, and suggest potential harm with overly aggressive therapy.

synapsesocial.com/papers/6a1641de512cb4f7828ea9b5 https://doi.org/https://doi.org/10.3949/ccjm.78a.10101

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