Are More-Intensive Blood Pressure Regimens Safe, Effective?

Intensive efforts to lower blood pressure are associated with less risk of cardiovascular disease than standard regiments, according to a recent survey.

The study comes in response to recent changes to hypertension guidelines, lowering targets for high-risk patients. For this reason, researchers aimed to evaluated the safety and efficacy of intensive blood pressure-lowering methods in these patients.
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Researchers conducted a systematic review and meta-analysis of data from 19 trials including 44,989 participants and 2496 cardiovascular events. Participants had been randomized to either more- or less-intensive blood pressure control regimens with average achieved blood pressure levels of 133/76 in intense regimens and 140/81 in less-intense regimens.

Overall, patients undergoing more intensive blood pressure control saw risk reductions of 14%, 13%, 22%, 10%, and 19% for cardiovascular events, myocardial infarction, stroke, albuminuria, and retinopathy progression, respectively. The intensive efforts, however, had no effect on risk of heart failure, cardiovascular death, total mortality, and end-stage kidney disease.

Serious adverse events related to blood pressure control were only reported in 6 trials with an event rate of 1.2% per year in those undergoing intensive blood pressure lowering and 0.9% in those undergoing less intensive treatment.

“Intensive blood pressure lowering provided greater vascular protection than standard regimens,” they concluded.

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

—Michael Potts

Reference:
Xie 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. November 2015 [epub ahead of print]. DOI: http://dx.doi.org/10.1016/S0140-6736(15)00805-3.