Intensive blood-pressure control for reducing adverse cardiovascular events in patients with and without diabetes or stroke: A systematic review and meta-analysis

Background More intensive systolic blood pressure (BP) targets have been proposed to improve cardiovascular outcomes, but the balance of benefit and risk remains uncertain. Methods MEDLINE, Embase, and the Cochrane Central Register were searched for trials comparing intensive (systolic BP <130 mmHg) versus less intensive (≥130 mmHg) targets. The primary outcome was a composite of major cardiovascular events (major adverse cardiovascular events [MACEs]). Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results Ten trials were included. Intensive BP lowering reduced the risk of MACEs compared with a less intensive strategy (RR: 0.77; 95% CI: 0.70–0.85). A lower BP target decreased the risk of cardiovascular death (RR: 0.73; 95% CI: 0.65–0.82), all-cause mortality (RR: 0.88; 95% CI, 0.82–0.95), stroke (RR: 0.76; 95% CI, 0.69–0.84), myocardial infarction (RR: 0.82; 95% CI, 0.73–0.92) and heart failure (RR: 0.71; 95% CI, 0.60–0.84). The results were largely consistent across the subpopulations of hypertension, diabetes, and stroke patients. There was no significant difference in the risk of acute coronary syndrome and revascularization between the two strategies. Conclusions Intensive treatment increased the incidence of hypotension and syncope but did not raise serious adverse event rates. Targeting systolic BP to <130 mmHg significantly reduces major cardiovascular events and mortality compared with higher BP targets, although this strategy was associated with increased risks of acute kidney injury, hypotension, syncope, and electrolyte abnormalities.