Key result
Intensive blood pressure treatment was associated with a significant increase in treatment-related serious adverse events compared with moderate treatment (P = 0.0002).
Why the study?
Although intensive antihypertensive treatment is advocated, whether it increases the frequency of serious adverse events compared with moderate control remained controversial.
Does intensive target-oriented blood pressure management increase serious adverse events compared to moderate management in patients with arterial hypertension?
Systematic Review (n=25,120)
Does intensive target-oriented blood pressure management increase serious adverse events compared to moderate management in patients with arterial hypertension?
Intensive antihypertensive treatment is associated with significantly elevated frequencies of serious adverse events compared with moderate treatment, highlighting the need to balance cardiovascular benefits with potential harms.
Warrants caution with intensive BP targets due to excess serious adverse events; confirms safety trade-offs across hypertension trials.
: On the basis of the benefits of antihypertensive treatment, progressively intensive treatment is advocated. However, it remains controversial whether intensive blood pressure control might increase the frequency of serious adverse events (SAEs) compared with moderate control. This review assessed the occurrence of SAEs in blood pressure treatment with predefined blood pressure targets. Seven original studies and eight post hoc analyses (derived from two original studies) met the inclusion criteria. Compared with moderate blood pressure treatment, intensive treatment was associated with a significant increase in treatment-related SAEs (Sign-test: P = 0.0002, Wilcoxon signed-rank test: P = 0.001). However, comparability between studies was limited, due to unclear determinations about the treatment-relatedness of adverse events, missing definitions of SAEs and variations in recording methods. Thus, a meta-analysis was not justified. The definitions of serious adverse events and methods of recording and reporting need to be improved and standardized to facilitate the comparison of results.
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Frey et al. (2019) conducted a systematic review in Arterial hypertension (n=25,120). Intensive blood pressure treatment vs. Moderate blood pressure treatment was evaluated on Treatment-related serious adverse events (p=0.0002). Intensive blood pressure treatment was associated with a significant increase in treatment-related serious adverse events compared with moderate treatment (P = 0.0002).
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