intensive blood pressure control
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Clinical significance
- unknown
- benefit-to-harm ratio favorable at all cardiovascular risk levels[2]
- fewer cardiovascular events than standard BP control (absolute reduction, 1.7%) but more treatment-related adverse events (absolute increase, 1.8%)[3]*
- number needed to treat was 58, largely due to stroke reduction[3]*
- benefits greatest in younger patients, patients with stroke, absence of chronic kidney disease, & baseline diastolic BP >= 70 mm Hg[3]*
- more harm at highest risk level (still greater benefit)[2]
- in the Sprint study, investigators did not come close to achieving target BP
- STEP trial conducted in China with wide target range for systolic BP
- numerous publications would appear to be in conflict with recommendations for intensive blood pressure control in the elderly. See systolic hypertension & blood pressure in the very old.
* pooled analysis of trial with systolic BP targets of < 120 & < 130 mm Hg[3]
* analyzed separately, the systolic BP target of < 120 mm of Hg is associated with greater absolute reduction in cardiovascular events (1.8% vs 1.6%) but a higher incidence of treatment-related adverse events (9.3% vs 3.6%)[3]
Clinical trials
Notes
More general terms
References
- ↑ 1.0 1.1 Juraschek SP, Hu JR, Cluett JL et al. Orthostatic Hypotension, Hypertension Treatment, and Cardiovascular Disease: An Individual Participant Meta-Analysis. JAMA. 2023 Oct 17;330(15):1459-1471. PMID: https://pubmed.ncbi.nlm.nih.gov/37847274 PMCID: PMC10582789 (available on 2024-04-17) https://jamanetwork.com/journals/jama/fullarticle/2810698
- ↑ 2.0 2.1 2.2 Dong X, Ling Q, Zhao X, Song Q, Cai J. Benefit and harm of intensive blood pressure control by cardiovascular risk. Hypertension 2025 Aug; 82:1392. PMID: https://pubmed.ncbi.nlm.nih.gov/40567237 https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.125.25162
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Guo X, Sun G, Xu Y et al. Benefit-harm trade-offs of intensive blood pressure control versus standard blood pressure control on cardiovascular and renal outcomes: An individual participant data analysis of randomised controlled trials. Lancet 2025 Sep 6; 406:1009 PMID: https://pubmed.ncbi.nlm.nih.gov/40902616