Key result
Antihypertensives reduce MACE with an NNT of 47 in patients with SBP 140-159.9 mmHg.
Why the study?
The blood pressure threshold for initiating pharmacological treatment remains controversial.
Do antihypertensive medications reduce major adverse cardiovascular events in adults with different baseline systolic blood pressures?
Meta-Analysis (n=213,342)
Do antihypertensive medications reduce major adverse cardiovascular events in adults with different baseline systolic blood pressures?
Antihypertensive therapy provides cardiovascular benefit at SBP ≥140 mmHg generally, and at ≥130 mmHg for high-risk patients, supporting risk-stratified blood pressure targets.
Background: The blood pressure (BP) threshold for initial pharmacological treatment remains controversial. The number needed to treat (NNT) is a significant indicator. This study aimed to explore the benefits and risks of antihypertensive medications in participants with different systolic BPs (SBPs), and cardiovascular disease status from the perspective of the NNT. Methods: We conducted a meta-analysis of 52 randomized placebo-controlled trials. The data were extracted from published articles and pooled to calculate NNTs. The participants were divided into five groups, based on the mean SBP at entry (120-129.9, 130-139.9, 140-159.9, 160-179.9, and ≥180 mmHg). Furthermore, we stratified patients into those with and without cardiovascular disease. The primary outcomes were the major adverse cardiovascular events (MACEs), and adverse events (AEs) leading to discontinuation. Results: Antihypertensive medications were not associated with MACEs, however, it increased AEs, when the SBP was <140 mmHg. For participants with cardiovascular disease or at a high risk of heart failure and stroke, antihypertensive treatment reduced MACEs when SBP was ≥130 mmHg. Despite this, only 2-4 subjects had reduced MACEs per 100 patients receiving antihypertensive medications for 3.50 years. The number of individuals who needed to treat to avoid MACEs declined with an increased cardiovascular risk. Conclusion: Pharmacological treatment could be activated when SBP reaches 140 mmHg. For people with cardiovascular disease or at a higher risk of stroke and heart failure, 130 mmHg may be a better therapeutic threshold. It could be more cost-effective to prioritize antihypertensive medications for people with a high risk of developing cardiovascular disease.
No takes yet. Share an insight, caveat, or question.
Mao et al. (2022) conducted a meta-analysis in Hypertension (n=213,342). Antihypertensive medications vs. Placebo was evaluated on Major adverse cardiovascular events (MACEs) in patients with SBP 140-159.9 mmHg (NNT 47, 95% CI 34-100). Antihypertensive medications reduced major adverse cardiovascular events with a number needed to treat of 47 in patients with a systolic blood pressure of 140-159.9 mmHg.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: