A Cochrane review [Abstract] 1 included 4 studies with a total of 16 732 subjects (mean age 70.3 years). One study compared a higher blood pressure (BP) target of < 150/90 mmHg to a lower target of < 140/90 mmHg, and 2 studies compared a purely systolic BP target of < 150 mmHg (1 study) and a systolic BP < 160 mmHg (1 study), to a systolic BP < 140 mmHg. The fourth study compared systolic BP target of 130 to 150 mmHg to a lower target of 110 to 130 mmHg.
There was no difference in all-cause mortality between higher and lower BP target over 2 to 4 years (table T1). The risk of stroke was increased with the higher BP target compared to the lower BP target, as was the risk of total serious cardiovascular adverse events, and the risk of cardiovascular mortality (RR 1.48, 95% CI 1.08 to 2.02; 4 studies, n=16 732). There was no difference in total serious adverse events (death, hospitalization and/or events requiring medical treatment; RR 0.93, 95% CI 0.69 to 1.24; 1 study, n=3 079) or withdrawals due to adverse effects (table T1).
| Relative effect (95% CI) | Risk with lower BP target | Risk with higher BP target (95% CI) | Participants (studies) | |
|---|---|---|---|---|
| All-cause mortality | RR 1.14(0.95 to 1.37) | 23 per 1000 | 27 per 1000(22 to 32) | 16 732(4) |
| Stroke | RR 1.33(1.06 to 1.67) | 15 per 1000 | 21 per 1000(16 to 26) | 16 732(4) |
| Serious cardiovascular adverse events* | RR 1.25(1.09 to 1.45) | 38 per 1000 | 48 per 1000(42 to 55) | 16 732(4) |
| Withdrawals due to adverse effects | RR 0.99(0.74 to 1.33) | 11 per 1000 | 11 per 1000(8 to 15) | 16 008(3) |
| * cerebrovascular disease, cardiac disease, vascular disease, and renal failure | ||||
Clinical comments
NoteUncertainty still remains for the 'oldest old' (80 years of age and older), those who are frail, and those who have low diastolic BP at baseline. Date of latest search: References
Primary/Secondary Keywords
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