Targeting systolic blood pressure <120 mm Hg reduced major vascular events compared with <140 mm Hg (9.7% vs 11.1%; HR 0.88, 95% CI 0.78-0.99; p=0.028).
RCT (n=11,255)
open-label, blinded-outcome
minimised randomisation
Yes
Does intensive treatment targeting systolic blood pressure <120 mm Hg reduce the composite of myocardial infarction, revascularisation, hospitalisation for heart failure, stroke, or cardiovascular death in patients with high cardiovascular risk compared to standard treatment targeting <140 mm Hg?
Targeting a systolic blood pressure of <120 mm Hg compared with <140 mm Hg significantly reduces major vascular events in high-risk patients, including those with diabetes or prior stroke, with a minor increase in syncope.
Hazard Ratio: 0.88 (95% CI 0.78–0.99)
Absolute Event Rate: 9.7% vs 11.1%
p-value: p=0.028
BACKGROUND Uncertainty exists about whether lowering systolic blood pressure to less than 120 mm Hg is superior to that of less than 140 mm Hg, particularly in patients with diabetes and patients with previous stroke. METHODS In this open-label, blinded-outcome, randomised controlled trial, participants with high cardiovascular risk were enrolled from 116 hospitals or communities in China. We used minimised randomisation to assign participants to intensive treatment targeting standard office systolic blood pressure of less than 120 mm Hg or standard treatment targeting less than 140 mm Hg. The primary outcome was a composite of myocardial infarction, revascularisation, hospitalisation for heart failure, stroke, or death from cardiovascular causes, assessed by the intention-to-treat principle. This trial was registered with ClinicalTrials.gov, NCT04030234. FINDINGS Between Sept 17, 2019, and July 13, 2020, 11 255 participants (4359 with diabetes and 3022 with previous stroke) were assigned to intensive treatment (n=5624) or standard treatment (n=5631). Their mean age was 64·6 years (SD 7·1). The mean systolic blood pressure throughout the follow-up (except the first 3 months of titration) was 119·1 mm Hg (SD 11·1) in the intensive treatment group and 134·8 mm Hg (10·5) in the standard treatment group. During a median of 3·4 years of follow-up, the primary outcome event occurred in 547 (9·7%) participants in the intensive treatment group and 623 (11·1%) in the standard treatment group (hazard ratio HR 0·88, 95% CI 0·78-0·99; p=0·028). There was no heterogeneity of effects by diabetes status, duration of diabetes, or history of stroke. Serious adverse events of syncope occurred more frequently in the intensive treatment group (24 0·4% of 5624) than in standard treatment group (eight 0·1% of 5631; HR 3·00, 95% CI 1·35-6·68). There was no significant between-group difference in the serious adverse events of hypotension, electrolyte abnormality, injurious fall, or acute kidney injury. INTERPRETATION For hypertensive patients at high cardiovascular risk, regardless of the status of diabetes or history of stroke, the treatment strategy of targeting systolic blood pressure of less than 120 mm Hg, as compared with that of less than 140 mm Hg, prevents major vascular events, with minor excess risk. FUNDING The Ministry of Science and Technology of China and Fuwai Hospital. TRANSLATION For the Mandarin translation of the abstract see Supplementary Materials section.
“Our study provides evidence to support targeting systolic blood pressure to less than 120 mm Hg in hypertensive patients with high cardiovascular risk and normal or mild-reduced kidney function, regardless of their diabetes status (Type 1, Type 2 or none) or history of stroke.”
Liu et al. (2024) conducted an RCT in high cardiovascular risk (n=11,255). Intensive treatment targeting systolic blood pressure <120 mm Hg vs. Standard treatment targeting systolic blood pressure <140 mm Hg was evaluated on composite of myocardial infarction, revascularisation, hospitalisation for heart failure, stroke, or death from cardiovascular causes (HR 0.88, 95% CI 0.78-0.99, p=0.028). Targeting systolic blood pressure <120 mm Hg reduced major vascular events compared with <140 mm Hg (9.7% vs 11.1%; HR 0.88, 95% CI 0.78-0.99; p=0.028).