Introduction: More intensive systolic blood pressure (BP) targets have been proposed to improve cardiovascular outcomes, but the balance of benefit and risk remains uncertain. Hypothesis: Intensive lowering of systolic BP to 130 mmHg) targets. The primary outcome was a composite of major cardiovascular events (MACE). Secondary outcomes included cardiovascular death, all-cause mortality, stroke, myocardial infarction, and heart failure. Pooled relative risks (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Heterogeneity was quantified by inconsistency index. Results: Ten trials enrolling 83,580 participants met inclusion criteria. Intensive BP lowering reduced the risk of MACE compared with a less intensive strategy (RR 0.77; 95% CI, 0.70–0.85; p < 0.001; inconsistency index = 60%). Lower BP targets decreased the risk of cardiovascular death (RR 0.73; 95% CI, 0.65–0.82; p < 0.001; inconsistency index = 0%), all-cause mortality (RR 0.88; 95% CI, 0.82–0.95; p = 0.002; inconsistency index= 11%), stroke (RR 0.76; 95% CI, 0.69–0.84; p < 0.001; inconsistency index = 33%), myocardial infarction (RR 0.82; 95% CI, 0.73–0.92; p = 0.001; inconsistency index = 0%), and heart failure (RR 0.71; 95% CI, 0.60–0.84; p < 0.001; inconsistency index = 16%). There was no significant difference in acute coronary syndrome and revascularization (RR 0.89; 95% CI, 0.75–1.06; p = 0.18; inconsistency index= 40%). The results of the primary analysis remain consistent among the subgroups of diabetes and stroke. Intensive treatment increased hypotension and syncope but did not raise serious adverse event rates. Conclusions: Targeting systolic BP to <130 mmHg significantly lowers major cardiovascular events and mortality compared with higher BP targets, with an acceptable safety profile. These findings support adopting lower systolic BP goals in high-risk populations.
Nawab et al. (Mon,) studied this question.