The quality of evidence is downgraded by imprecise results (few outcome events and wide confidence intervals).
A Cochrane review [Abstract] 1 included 7 studies with a total of 9 595 subjects. The aim of the review was to determine if lower blood pressure (BP) targets (≤ 135/85 mmHg) are associated with reduction in mortality and morbidity as compared with standard BP targets (≤ 140 to 160/ 90 to 100 mmHg) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease). Mean follow-up was 3.7 years. BP targets were more frequently achieved in the standard BP target arm (75%) than the lower target arm (64%). More antihypertensive drugs were used in the lower BP target group (average 2.4 drugs) than in the standard arm (average 1.9 drugs). Blood pressures were lower in the lower target group by 8.8 mmHg/4.5 mmHg.
No changes in total mortality, cardiovascular mortality, fatal and non-fatal cardiovascular events (including myocardial infarction, stroke, sudden death, hospitalization, or death from congestive heart failure), or serious adverse events were found (table T1). More participant withdrew due to adverse effects in the lower target arm.
| Outcome | Relative effect (95% CI) | Risk with standard BP target | Risk with lower BP target (95% CI) | Participants (studies) |
|---|---|---|---|---|
| Total mortality | RR 1.05(0.91 to 1.23) | 68 per 1000 | 71 per 1000(62 to 84) | 9 595(7) |
| Cardiovascular mortality | RR 1.03(0.82 to 1.29) | 31 per 1000 | 32 per 1000(25 to 40) | 9 484(6) |
| Total cardiovascular events | RR 0.89(0.80 to 1.00) | 127 per 1000 | 113 per 1000(102 to 127) | 9 595(7) |
| Serious adverse events | RR 1.01(0.94 to 1.08) | 252 per 1000 | 255 per 1000(237 to 272) | 9 595(7) |
| Withdrawals due toadverse effects | RR 8.16(2.06 to 32.28) | 7 per 1000 | 60 per 1000(15 to 239) | 801(3) |
Clinical comments
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