April 1, 2009Journal of Hypertension
Facts and fallacies of blood pressure control in recent trials: implications in the management of patients with hypertension
Why the study?
Does lowering systolic blood pressure below 140 or 130 mmHg improve outcomes in patients with hypertension?
Population
Patients with hypertension
Design
Review
Authors
Discussion
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Member takes
Implication
Insufficient evidence to endorse systolic targets below 140 mmHg; leaves open whether dedicated trials would confirm outcome benefit.
Key Points
- To evaluate findings from recent comparative trials regarding whether the relationship between blood pressure reduction and cardiovascular outcome benefits remains consistent across diverse risk groups and target thresholds.
- Reviewed and analyzed the methodological designs and outcome data from six recent comparative clinical trials evaluating blood pressure lowering in hypertension.
- Observed that a fixed linear relationship between the magnitude of blood pressure reduction and cardiovascular benefit does not consistently hold across all blood pressure ranges, cardiovascular risk tiers, or drug regimens.
- Determined that the intricate designs of recent comparative trials hinder straightforward interpretation, leaving a lack of direct evidence to justify lowering systolic targets below 140 or 130 mmHg.
Structured PICO
Does lowering systolic blood pressure below 140 or 130 mmHg improve outcomes in patients with hypertension?
P
Population
Patients with hypertension
I
Intervention
Blood pressure lowering (specifically lowering systolic blood pressure below 140 or 130 mmHg)
O
Outcome
Outcome benefit
Recent trial data challenges the assumption of a fixed relationship between blood pressure lowering and outcome benefit across all ranges, emphasizing the need for direct evidence for aggressive systolic blood pressure targets.
Limitations
- Complex design of reviewed trials precludes simple interpretation
Cite This Study
Zanchetti et al. (2009) studied this question.