Key result
Each mm Hg reduction in mean SBP is linked to ~2% greater BP control.
Why the study?
The relationship between mean BP and BP control remained uncertain, particularly the mean BP required to achieve BP control (<140/90 mm Hg) in most patients.
What is the association between mean follow-up blood pressure and the proportion of patients achieving blood pressure control (<140/90 mm Hg) in adults receiving BP-lowering interventions?
Meta-Analysis (n=85,355)
Yes
What is the association between mean follow-up blood pressure and the proportion of patients achieving blood pressure control (<140/90 mm Hg) in adults receiving BP-lowering interventions?
Effect estimate: 2% increase per 1 mm Hg reduction in mean SBP
A mean follow-up systolic blood pressure below 125 mm Hg is required to achieve standard blood pressure control (<140/90 mm Hg) in approximately 80% of patients.
Targeting lower mean SBP boosts control rates; reinforces RCT-derived targets for hypertension guidelines.
BACKGROUND: The relationship between mean blood pressure (BP) and BP control remains uncertain, particularly the mean BP required to achieve BP control (<140/90 mm Hg) in most patients. This review assesses the association between mean BP and BP control using data from randomized clinical trials (RCTs). METHODS: Electronic literature databases were searched to identify individual RCTs (iRCTs) and cluster RCTs (cRCTs) that randomized adults to BP-lowering interventions and reported both mean BP at final follow-up visit (mean BP) and the proportion of participants achieving BP control at the final follow-up visit (BP control). RESULTS: A linear regression model was used to evaluate the association between mean BP and BP control. A total of 101 RCTs (65 iRCTs [57 201 participants] and 36 cRCTs [28 154 participants]) were included. Overall, mean systolic BP (SBP) of 120, 125, 130, and 135 mm Hg corresponded to BP control in 85%, 75%, 65% and 55% of the participants in iRCTs and 87%, 77%, 67%, 57% in cRCTs. Each 1 mm Hg reduction in mean SBP was associated with approximately a 2% increase in BP control (Pseudo- R 2 =78% for iRCTs; 76% for cRCTs). This association was consistent across BP-lowering drug classes, baseline SBP categories, and pretrial treatment status in iRCTs, and across country income levels and baseline SBP categories in cRCTs. A similar association was seen for DBP. CONCLUSIONS: An SBP below 125 mm Hg was associated with achieving BP control in ≈80% of patients. These findings can inform guideline recommendations, guide clinical management and shape hypertension control programs.
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Salam et al. (2026) conducted a meta-analysis in Hypertension (n=85,355). Mean blood pressure reduction was evaluated on Proportion of participants achieving BP control (<140/90 mm Hg) at final follow-up (2% increase per 1 mm Hg reduction in mean SBP). Each 1 mm Hg reduction in mean systolic blood pressure was associated with approximately a 2% increase in blood pressure control across 101 randomized trials.
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