Full Article
Evidence Summary
What is an Evidence Summary?
Key messages from scientific research that's ready to be acted on
Got It, Hide thisIn people using blood pressure–lowering drugs, more-intensive therapy reduces cardiovascular events and strokes more than less-intensive therapy
Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387:435-43.
Review question
In people who are prescribed drugs to lower blood pressure, does more-intensive therapy reduce the risk for major cardiovascular events (e.g., heart attack, heart failure) and stroke compared with less-intensive therapy?
Background
People with high blood pressure and some other conditions (e.g., diabetes, kidney disease) are more likely than many other people to have a major cardiovascular event. High blood pressure is usually defined as having a systolic blood pressure (SBP) of 140 mm Hg or more or a diastolic blood pressure (DBP) of 90 mm Hg or more.
Drugs that lower blood pressure can reduce risk for cardiovascular events. More-intensive drug therapy can reduce blood pressure more than less-intensive drug therapy. It may also be better for reducing cardiovascular events but could have more side effects.
How the review was done
The researchers did a systematic review, searching for studies that were published up to November 2015.
They found 18 randomized controlled trials with 44,604 adults (average age 41 to 77 years, 37% to 74% men) and 1 randomized controlled trial with 385 children (average age 12 years, 59% boys).
The key features of the studies were:
- most people had high blood pressure; some had diabetes, chronic kidney disease, or more than one condition that increased risk for cardiovascular events;
- drugs were used to reduce blood pressure to specific levels or by specific amounts;
- more-intensive therapy was compared with less-intensive therapy;
- more-intensive therapy aimed to reduce blood pressure more than less-intensive therapy; and
- people were followed up for at least 6 months (3.8 years on average).
What the researchers found
Compared with less-intensive therapy, more-intensive blood pressure–lowering therapy:
- reduced blood pressure (SBP by 6.8 mm Hg and DBP by 3.5 mm Hg);
- reduced major cardiovascular events and stroke;
- had similar rates of death, heart attack, heart failure, and end-stage kidney disease; and
- had higher rates of severe low blood pressure, which can cause dizziness or fainting, although yearly event rates were low in both groups (0.1% in the lower-intensity group vs 0.3% in the higher-intensity group, with adverse events leading to discontinuation of treatment in 1% for each group).
Conclusion
In people who are prescribed drugs to lower blood pressure, more-intensive therapy reduces cardiovascular events and strokes more than less-intensive therapy.
More- vs less-intensive blood pressure–lowering therapy*
| Outcomes | Number of trials and people | Rate of events with more-intensive therapy | Rate of events with less-intensive therapy | Absolute effect of more-intensive therapy at an average 3.8 years |
| Major CV events† | 14 trials (43,483 people) | 4.9% | 5.7% | About 8 fewer people out of 1,000 had a major CV event (from as few as 3 to as many as 13) |
| Death from any cause | 19 trials (44,989 people) | 3.5% | 3.8% | No difference in effect‡ |
| Death because of CV events | 13 trials (42,372 people) | 1.6% | 1.8% | No difference in effect‡ |
| Death from any cause other than CV events | 12 trials (41,993 people) | 2.0% | 2.0% | No difference in effect |
| Heart attack | 13 trials (42,389 people) | 1.7% | 1.9% | No difference in effect‡ |
| Heart failure | 10 trials (33,306 people) | 0.9% | 1.1% | No difference in effect‡ |
| Stroke | 14 trials (43,483 people) | 2.0% | 2.6% | About 6 fewer people out of 1,000 had a stroke (from as few as 3 to as many as 9) |
| End-stage kidney disease§ | 8 trials (8,690 people) | 5.8% | 6.4% | No difference in effect‡ |
Related Topics
Glossary
The lower number in a blood pressure reading. It is the pressure when the heart rests between beats.
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
The higher number in a blood pressure reading. It is the pressure in the arteries when the heart beats.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.
Related Evidence Summaries
-
Calcium supplementation for prevention of primary hypertension
Cochrane Database Syst Rev (2021)
-
In adults with pre-hypertension to established hypertension, Dietary Approach to Stop Hypertension (DASH) may be the most effective non-drug strategy for reducing blood pressure
Journal of the American Heart Association (2020)
-
Providing patients and their care providers with information about cardiovascular disease risk may help with prevention measures
BMJ Open (2015)
