Intensive antihypertensive treatment goals (< 130/80 mmHg) reduced the composite of myocardial infarction, stroke, and all-cause mortality by 13% compared to conventional goals.
Systematic Review (n=32,749)
Does intensive antihypertensive treatment (< 130/80 mmHg) reduce cardiovascular events in adults with hypertension compared to conventional goals?
Intensive blood pressure control (< 130/80 mmHg) significantly reduces cardiovascular events compared to conventional goals, supporting stricter targets in hypertension management.
Effect estimate: RR 0.87 (95% CI 0.80-0.94)
Absolute Event Rate: 7.7% vs 8.9%
Abstract Background Strict blood pressure control has been investigated as a strategy to reduce severe cardiovascular events in patients with hypertension. However, there are still doubts about the impact of intensive antihypertensive treatment goals (< 130/80 mmHg) compared to conventional goals (≥ 130/80 mmHg) in preventing myocardial infarction, stroke, mortality, and possible treatment-related adverse effects. Objective To evaluate the effectiveness of intensive antihypertensive treatment goals in reducing critical cardiovascular events compared to usual goals. Methods This systematic review included randomized controlled trials (RCTs) that compared intensive blood pressure control goals with conventional goals in adults aged 18 years or older. Studies with at least one of the following outcomes were included: mortality, myocardial infarction, stroke, progression to stage 4 or 5 chronic kidney disease, need for dialysis, or kidney transplantation. Medline, Embase, and Cochrane Library databases were searched up to May 2024. Risk of bias assessment was performed by two independent reviewers using the Cochrane Collaboration’s Risk of Bias 2 (RoB 2) tool. Synthesis of results was conducted through meta-analysis for the composite outcome of myocardial infarction, stroke, and all-cause mortality. The certainty of scientific evidence and strength of recommendation followed the methods proposed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Results Nine RCTs with more than 34,000 participants were included. Intensive treatment was associated with a 13% reduction in cardiovascular events. In the studies with low risk of bias, the reduction was 17%, with high certainty of evidence. Separately, a significant reduction was observed in the outcomes of myocardial infarction and stroke, but not in all-cause mortality. Limited data were found on the progression of kidney disease and the need for dialysis or kidney transplantation. Conclusion High-quality evidence suggests that more intensive antihypertensive treatment goals significantly reduce cardiovascular events. However, the choice of treatment goals should be individualized, considering factors such as age, frailty, individual cardiovascular risk, and the possibility of adverse events. Adherence to treatment is essential to therapeutic success.
Brandão et al. (Sat,) conducted a systematic review in Hypertension (n=32,749). Intensive antihypertensive treatment vs. Conventional antihypertensive treatment (≥ 130/80 mmHg) was evaluated on Composite of myocardial infarction, stroke, and all-cause mortality (RR 0.87, 95% CI 0.80-0.94). Intensive antihypertensive treatment goals (< 130/80 mmHg) reduced the composite of myocardial infarction, stroke, and all-cause mortality by 13% compared to conventional goals.