Key messages from scientific research that's ready to be acted on
Got It, Hide thisXie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387:435-43.
In people who are prescribed drugs to lower blood pressure, does more-intensive therapy reduce the risk for major cardiovascular events (e.g., heart attack, heart failure) and stroke compared with less-intensive therapy?
People with high blood pressure and some other conditions (e.g., diabetes, kidney disease) are more likely than many other people to have a major cardiovascular event. High blood pressure is usually defined as having a systolic blood pressure (SBP) of 140 mm Hg or more or a diastolic blood pressure (DBP) of 90 mm Hg or more.
Drugs that lower blood pressure can reduce risk for cardiovascular events. More-intensive drug therapy can reduce blood pressure more than less-intensive drug therapy. It may also be better for reducing cardiovascular events but could have more side effects.
The researchers did a systematic review, searching for studies that were published up to November 2015.
They found 18 randomized controlled trials with 44,604 adults (average age 41 to 77 years, 37% to 74% men) and 1 randomized controlled trial with 385 children (average age 12 years, 59% boys).
The key features of the studies were:
Compared with less-intensive therapy, more-intensive blood pressure–lowering therapy:
In people who are prescribed drugs to lower blood pressure, more-intensive therapy reduces cardiovascular events and strokes more than less-intensive therapy.
Outcomes | Number of trials and people | Rate of events with more-intensive therapy | Rate of events with less-intensive therapy | Absolute effect of more-intensive therapy at an average 3.8 years |
Major CV events† | 14 trials (43,483 people) | 4.9% | 5.7% | About 8 fewer people out of 1,000 had a major CV event (from as few as 3 to as many as 13) |
Death from any cause | 19 trials (44,989 people) | 3.5% | 3.8% | No difference in effect‡ |
Death because of CV events | 13 trials (42,372 people) | 1.6% | 1.8% | No difference in effect‡ |
Death from any cause other than CV events | 12 trials (41,993 people) | 2.0% | 2.0% | No difference in effect |
Heart attack | 13 trials (42,389 people) | 1.7% | 1.9% | No difference in effect‡ |
Heart failure | 10 trials (33,306 people) | 0.9% | 1.1% | No difference in effect‡ |
Stroke | 14 trials (43,483 people) | 2.0% | 2.6% | About 6 fewer people out of 1,000 had a stroke (from as few as 3 to as many as 9) |
End-stage kidney disease§ | 8 trials (8,690 people) | 5.8% | 6.4% | No difference in effect‡ |
Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.