Key result
Tight blood pressure control (systolic <130 mmHg) was associated with a significantly lower incidence of stroke compared to standard control (OR 0.583), but did not affect the incidence of myocardial infarction.
Why the study?
The 2017 ACC/AHA guideline revised the definition of hypertension to BP ≥ 130/80 mmHg, which raised controversy regarding the clinical impact of tight versus standard blood pressure control on myocardial infarction and stroke.
Does tight blood pressure control (< 130 mmHg) reduce the incidence of myocardial infarction and stroke in hypertensive patients?
Cohort (n=5,640)
No
Does tight blood pressure control (< 130 mmHg) reduce the incidence of myocardial infarction and stroke in hypertensive patients?
Tight blood pressure control (<130 mmHg) is associated with a reduced incidence of stroke, but not myocardial infarction, compared to standard control (130-139 mmHg) in hypertensive patients.
Tight BP control associated with lower stroke incidence; hypothesis-generating for targets, needs prospective confirmation.
Background: The 2017 American College of Cardiology and American Heart Association guideline defined hypertension as blood pressure (BP) ≥ 130/80 mmHg compared to the traditional definition of ≥ 140/90 mmHg. This change raised much controversy. We conducted this study to evaluate incidences of myocardial infarction (MI) and stroke comparing tight (TBPC) and standard BP control (SBPC). Methods: The data were collected and analyzed in 2018. We retrospectively identified hypertensive patients for 1 year at our institution who were classified by BP rate across 3 years into 2 groups of TBPC (< 130 mmHg) and SBPC (130-139 mmHg). We compared the incidence of new MI and stroke between the 2 groups across a 2-year follow-up. Multivariate analysis was done to identify independent risk factors. Results: Of 5640 study patients, the TBPC group showed significantly less incidence of stroke compared to the SBPC group. No differences were found in MI incidence between the 2 groups. Multivariate analysis showed that increased age independently increased the incidence of both MI and stroke, and TBPC independently decreased the incidence of stroke but not of MI. Conclusions: Our observational study suggests that TBPC may be beneficial in less stroke incidence compared to SBPC but it didn’t seem to affect the incidence of MI. Our study is limited by its retrospective design with potential confounders.
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Park et al. (2020) conducted a cohort in Hypertension (n=5,640). Tight blood pressure control (SBP < 130 mmHg) vs. Standard blood pressure control (SBP 130-139 mmHg) was evaluated on Incidence of new stroke (OR 0.583, 95% CI 0.374-0.910, p=0.018). Tight blood pressure control (systolic <130 mmHg) was associated with a significantly lower incidence of stroke compared to standard control (OR 0.583), but did not affect the incidence of myocardial infarction.
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