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Article: Determining the Optimal Systolic Blood Pressure for Hypertensive Patients: A Network Meta-analysis

TitleDetermining the Optimal Systolic Blood Pressure for Hypertensive Patients: A Network Meta-analysis
Authors
Keywordsall cause mortality
blood pressure regulation
cardiovascular disease
cardiovascular mortality
cerebrovascular accident
Issue Date2018
PublisherElsevier Inc. The Journal's web site is located at http://www.onlinecjc.ca/
Citation
Canadian Journal of Cardiology, 2018, v. 34 n. 12, p. 1581-1589 How to Cite?
AbstractBackground: There is clinical trial evidence that lowering systolic blood pressure (SBP) to < 120 mm Hg is beneficial, and this has influenced the latest American guideline on hypertension. We therefore used network meta-analysis to study the association between SBP and cardiovascular outcomes. Methods: We searched for randomized controlled trials targeting different blood pressure levels that reported cardiovascular events. The mean achieved SBP in each trial was classified into 5 groups (110-119, 120-129, 130-139, 140-149, and 150-159 mm Hg). The primary variables of cardiovascular mortality, stroke, and myocardial infarction were assessed using frequentist and Bayesian approaches. Results: Fourteen trials with altogether 44,015 patients were included. Stroke and major adverse cardiovascular events were reduced when lowering SBP to 120-129 mm Hg compared with 130-139 mm Hg (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.69-0.99 and OR 0.84, 95% CI 0.73-0.96), 140-149 mm Hg (OR 0.73, 95% CI 0.55-0.97 and OR 0.74, 95% CI 0.60-0.90), and 150-159 mm Hg (OR 0.43, 95% CI 0.26-0.71 and OR 0.41, 95% CI 0.30-0.57), respectively. More intensive control to < 120 mm Hg further reduced stroke (OR 0.58, 95% CI 0.38-0.87; OR 0.51, 95% CI 0.32-0.81; and OR 0.30, 95% CI 0.16-0.56). In contrast, SBP ≥ 150 mm Hg increased myocardial infarction and cardiovascular mortality compared with 120-129 mm Hg (OR 1.73, 95% CI 1.06-2.82 and OR 2.18, 95% CI 1.32-3.59) and 130-139 mm Hg (OR 1.53, 95% CI 1.01-2.32 and OR 1.71, 95% CI 1.11-2.61). No significant relationship between SBP and all-cause mortality was found. Conclusions; SBP < 130 mm Hg is associated with a lower risk of stroke and major adverse cardiovascular events. Further lowering to < 120 mm Hg can be considered to reduce stroke risk if the therapy is tolerated. Long-term SBP should not exceed 150 mm Hg because of the increased risk of myocardial infarction and cardiac deaths.
Persistent Identifierhttp://hdl.handle.net/10722/273951
ISSN
2017 Impact Factor: 4.524
2015 SCImago Journal Rankings: 1.333

 

DC FieldValueLanguage
dc.contributor.authorFei, Y-
dc.contributor.authorTsoi, MF-
dc.contributor.authorCheung, BMY-
dc.date.accessioned2019-08-18T14:52:01Z-
dc.date.available2019-08-18T14:52:01Z-
dc.date.issued2018-
dc.identifier.citationCanadian Journal of Cardiology, 2018, v. 34 n. 12, p. 1581-1589-
dc.identifier.issn0828-282X-
dc.identifier.urihttp://hdl.handle.net/10722/273951-
dc.description.abstractBackground: There is clinical trial evidence that lowering systolic blood pressure (SBP) to < 120 mm Hg is beneficial, and this has influenced the latest American guideline on hypertension. We therefore used network meta-analysis to study the association between SBP and cardiovascular outcomes. Methods: We searched for randomized controlled trials targeting different blood pressure levels that reported cardiovascular events. The mean achieved SBP in each trial was classified into 5 groups (110-119, 120-129, 130-139, 140-149, and 150-159 mm Hg). The primary variables of cardiovascular mortality, stroke, and myocardial infarction were assessed using frequentist and Bayesian approaches. Results: Fourteen trials with altogether 44,015 patients were included. Stroke and major adverse cardiovascular events were reduced when lowering SBP to 120-129 mm Hg compared with 130-139 mm Hg (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.69-0.99 and OR 0.84, 95% CI 0.73-0.96), 140-149 mm Hg (OR 0.73, 95% CI 0.55-0.97 and OR 0.74, 95% CI 0.60-0.90), and 150-159 mm Hg (OR 0.43, 95% CI 0.26-0.71 and OR 0.41, 95% CI 0.30-0.57), respectively. More intensive control to < 120 mm Hg further reduced stroke (OR 0.58, 95% CI 0.38-0.87; OR 0.51, 95% CI 0.32-0.81; and OR 0.30, 95% CI 0.16-0.56). In contrast, SBP ≥ 150 mm Hg increased myocardial infarction and cardiovascular mortality compared with 120-129 mm Hg (OR 1.73, 95% CI 1.06-2.82 and OR 2.18, 95% CI 1.32-3.59) and 130-139 mm Hg (OR 1.53, 95% CI 1.01-2.32 and OR 1.71, 95% CI 1.11-2.61). No significant relationship between SBP and all-cause mortality was found. Conclusions; SBP < 130 mm Hg is associated with a lower risk of stroke and major adverse cardiovascular events. Further lowering to < 120 mm Hg can be considered to reduce stroke risk if the therapy is tolerated. Long-term SBP should not exceed 150 mm Hg because of the increased risk of myocardial infarction and cardiac deaths.-
dc.languageeng-
dc.publisherElsevier Inc. The Journal's web site is located at http://www.onlinecjc.ca/-
dc.relation.ispartofCanadian Journal of Cardiology-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectall cause mortality-
dc.subjectblood pressure regulation-
dc.subjectcardiovascular disease-
dc.subjectcardiovascular mortality-
dc.subjectcerebrovascular accident-
dc.titleDetermining the Optimal Systolic Blood Pressure for Hypertensive Patients: A Network Meta-analysis-
dc.typeArticle-
dc.identifier.emailCheung, BMY: mycheung@hkucc.hku.hk-
dc.identifier.authorityCheung, BMY=rp01321-
dc.description.naturepostprint-
dc.identifier.doi10.1016/j.cjca.2018.08.013-
dc.identifier.pmid30414702-
dc.identifier.scopuseid_2-s2.0-85055999361-
dc.identifier.hkuros302216-
dc.identifier.volume34-
dc.identifier.issue12-
dc.identifier.spage1581-
dc.identifier.epage1589-
dc.publisher.placeCanada-

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