December 2015 Newsline published online ahead of print.

Intensive blood pressure lowering may provide a greater reduction of major cardiovascular events, compared with standard regimens, according to a meta-analysis published in The Lancet.

Although high blood pressure has already been shown to be closely associated with health among high-risk patients, previous research had produced conflicting results regarding whether further lowering of blood pressure had an effect on the risk of cardiovascular events.

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Xinfang Xie,  MD, and colleagues analyzed 19 studies that included 44,989 participants from 1950 through October 2015. Patients in the more intensive blood pressure-lowering treatment group had mean blood pressure levels of 133/76 mm Hg, compared with 140/81 mm Hg in the less intensive treatment group.

The researchers found that intensive blood pressure-lowering treatment achieved RR reductions for major cardiovascular events (14%), myocardial infarction (13%), stroke (22%), albuminuria (10%), and retinopathy progression (19%). However, more intensive treatment had no clear effects on heart failure (15%), cardiovascular death (9%), total mortality (9%), or end-stage kidney disease (10%), according to the investigators.

“In high-risk patients, there are additional benefits from more intensive blood pressure lowering, including for those with systolic blood pressure below 140 mmHg,” stated Dr. Xie and colleagues. “The net absolute benefits of intensive blood pressure lowering in high-risk individuals are large.”

Serious adverse events occurred in similar numbers among both intensive and standard treatment groups. The intensive treatment group, however, had an almost threefold risk of hypotension. The researchers believe that more research can help reduce the risk of hypotension by determining the safest methods for achieving lower blood pressure.

“Xie and colleagues’ systematic review provides strong evidence that intensive blood pressure reduction is more beneficial than less intensive blood pressure reduction. This finding will pave the way for the treatment of a large number of additional patients compared with the number treated at present,” stated Mattias Brunström, MD, and Bo Carlberg, MD, from Umeå University in Sweden, in a related comment.