Effect of intensive versus standard blood pressure control on cardiovascular outcomes in adult patients with hypertension: a systematic review and meta-analysis

Abstract

We conducted a systematic review and meta-analysis to evaluate the effects of intensive versus standard antihypertensive therapy on cardiovascular outcomes in adult patients with hypertension. The primary endpoints were composite cardiovascular events, all-cause death, cardiovascular death, and serious adverse events. The secondary endpoints included cognitive impairment, hypotension, syncope, acute kidney injury, and composite renal outcomes. Eight trials classifying a systolic blood pressure (SBP) target of <130 mmHg as intensive control was adopted in the primary analysis. The intensive blood pressure (BP) control significantly reduced the relative risk (RR) for cardiovascular events and cardiovascular death compared to standard BP control (RR 0.83 [95% confidence interval, 0.76-0.90] and 0.74 [0.56-0.97], respectively). The intensive BP control tended to reduce the RR for all-cause death, but not significant (0.89 [0.78-1.02]). On the other hand, the intensive BP control significantly increased the RR for serious adverse events, hypotension, and syncope (1.59 [1.19-2.12], 1.96 [1.04-3.70], and 2.36 [1.95-2.85], respectively). The intensive BP control significantly increased the RR for acute kidney injury (2.65 [1.78-3.95]), but did not affect for composite renal outcomes (1.38 [0.83-2.31]). For cognitive impairment, no significant increase or decrease in risk was observed (0.93 [0.68-1.26]). Based on these findings, we recommend the intensive BP control targeting SBP below 130 mmHg to achieve significant reductions in cardiovascular events and cardiovascular death, accompanied by careful monitoring for potential adverse events including acute kidney injury, hypotension, syncope related with the intensive BP control.

Keywords: Adverse events; Cardiovascular death; Cardiovascular events; Intensive blood pressure control; Standard blood pressure control.