Systolic blood pressure targets below 120 mm Hg are associated with reduced mortality: A meta‐analysis

Abstract Background The optimal systolic blood pressure (SBP) target in patients with increased cardiovascular risk remains uncertain. This study evaluated the efficacy and safety of intensive SBP control (<120 mm Hg) compared to standard SBP control (<140 mm Hg) in patients with increased cardiovascular risk. Methods We conducted a systematic search of PubMed, Embase, Web of Science, and Cochrane Library for RCTs published from database inception through November 2024 that compared intensive SBP control (<120 mm Hg) with standard SBP control (<140 mm Hg) in adults with high cardiovascular risk. Efficacy outcomes included all‐cause mortality, major adverse cardiovascular events (MACE), cardiovascular death, stroke, myocardial infarction (MI), and heart failure. Safety outcomes included hypotension, syncope, arrhythmia, acute kidney injury, and electrolyte abnormalities. Results Five RCTs comprising 39,434 patients were included. The all‐cause mortality was significantly lower in the intensive SBP control group (672 of 19,712 3.4%) compared to the standard SBP control group (778 of 19,722 3.9%) (risk ratio 0.87 95% confidence interval, 0.76–0.99, p = 0.03). The incidence of MACE, cardiovascular death, MI, stroke, and heart failure was significantly lower in the intensive SBP control group as compared to standard SBP control group. The treatment effect (MACE) was consistent across all subgroups. Conversely, intensive SBP control was associated with an increased risk of hypotension, syncope, arrhythmia, acute kidney injury, and electrolyte abnormalities. Conclusions Targeting intensive SBP control to less than 120 mm Hg was associated with a lower incidence of all‐cause mortality and MACE but a higher incidence of adverse events.