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In people with coronary artery disease, intensive blood pressure control is linked to reduced stroke and heart failure but increased risk for too low blood pressure

Bangalore S, Kumar S, Volodarskiy A, et al. Blood pressure targets in patients with coronary artery disease: observations from traditional and Bayesian random effects meta-analysis of randomised trials. Heart. 2013;99:601-13.

Review question

In people with coronary artery disease, what are the ideal blood pressure targets?

Background

A blood pressure reading consists of 2 numbers, for example 140/90 mm Hg (or 140 over 90). The higher number (systolic BP) is the pressure in the arteries when the heart beats. The lower number (diastolic BP) is the pressure when the heart rests between beats.

Guidelines suggest that the ideal blood pressure for people with hypertension (high blood pressure) is less than 140/90 mm Hg.

Guidelines are often based on the agreement of specialists. It is important to know whether using these recommended blood pressure targets to lower blood pressure actually have an effect on important outcomes such as heart failure or stroke.

How the review was done

The researchers did a systematic review, searching for studies that were published up to February 2012. They found 15 randomized controlled trials with 66,504 patients (average age 57 to 66 years) who had coronary artery disease but no heart failure or heart attack.

In the 15 trials, drugs to reduce blood pressure were compared with placebo or with a different drug. The researchers grouped the study participants by their systolic blood pressure at the end of the trials:

  • 140 mm Hg or less (which they called standard blood pressure control) or
  • 135 mm Hg or less (which they called intensive ¬†blood pressure control)

The outcomes in these 2 groups were measured after an average of 3 years (ranging from 1 to 6 years).

What the researchers found

Compared with standard blood pressure control (≤ 140 mm Hg), intensive blood pressure control (≤ 135 mm Hg) was linked to

  • a 15% reduction in heart failure
  • a 10% reduction in stroke
  • a 105% increase in the rate of rate of too low blood pressure (which can cause fainting and falls)

Intensive and standard blood pressure control did not differ for death (any cause or due to heart and circulation problems) or for restoring circulation to obstructed blood vessels.

 

Compared with standard blood pressure control (≤ 140 mm Hg), very intensive blood pressure control (≤ 130 mm Hg) was linked to

  • an 8% reduction in heart attacks and chest pain from coronary artery disease
  • a 27% reduction in heart failure
  • a 17% reduction in stroke

Conclusion

In people with coronary artery disease, intensive control of systolic blood pressure was linked to a small reduction in stroke and heart failure but at the expense of an increased risk of too low blood pressure.

Intensive or very intensive blood pressure control compared with standard blood pressure control (≤ 140 mm Hg) in people with coronary artery disease

Outcomes

Intensive control (≤ 135 mm Hg)

Very intensive control (≤ 130 mm Hg)

Death

No difference

No difference

Death from heart or circulation problems

No difference

No difference

Heart failure

15% decrease

27% decrease

Stroke

10% decrease

17% decrease

Too low blood pressure

105% increase

103% increase

Heart attack

No difference

8% decrease

Chest pain from coronary artery disease

No difference

8% decrease

 




Glossary

Diastolic
The lower number in a blood pressure reading. It is the pressure when the heart rests between beats.
Placebo
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
Systolic
The higher number in a blood pressure reading. It is the pressure in the arteries when the heart beats.

Related Web Resources

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    Men over 40 and women past menopause or over 50 should get screened for coronary artery disease (CAD) every 1 to 3 years. Your risk is higher if you have diabetes, high blood pressure, abdominal obesity, kidney disease, family history of CAD or if you smoke.
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    Eat less saturated fats in your diet to help prevent heart disease. Eat less meat, butter, cheese and cream to improve your health long-term.
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