Many people with heart or vascular problems also have high blood pressure, and the latest update of the Cochrane Review of using blood pressure targets in their treatment was published in November 2022. Here's lead author, Luis Carlos Saiz from the Navarre Health Service in Pamplona Spain, to tell us about the review and its latest findings.
Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Many people with heart or vascular problems also have high blood pressure, and the latest update of the Cochrane Review of using blood pressure targets in their treatment was published in November 2022. Here's lead author, Luis Carlos Saiz from the Navarre Health Service in Pamplona Spain, to tell us about the review and its latest findings.
Luis Carlos: In the clinical context of a person with heart or vascular problems having high blood pressure some clinical guidelines recommend lower blood pressure goals (less than 135 mmHg systolic or 85 mmHg diastolic) rather than the standard goals for hypertensive patients without cardiovascular disease of a maximum of 140 to 160 mmHg systolic and of 90 to 100 mmHg diastolic. However, it's unclear whether these lower goals lead to overall health benefits.
In this, our third, update of the Cochrane review of blood pressure targets in people with cardiovascular disease we looked at the evidence up to January 2022. We included randomized controlled trials with more than 50 participants per group that provided at least six months' follow‐up. Participants were hypertensive adults with a cardiovascular history of myocardial infarction, stroke, peripheral vascular disease or angina pectoris. In addition, trial reports had to present data for at least one of the following outcomes: total mortality, serious adverse events, total cardiovascular events or cardiovascular mortality.
We now include seven trials that enrolled almost 10,000 participants, of which six provided us with their individual participant data. Based on this evidence, we found that there is probably little to no difference in total mortality or cardiovascular mortality between lower and standard blood pressure goals. Similarly, there was little to no differences in serious adverse events or total cardiovascular events, but the evidence for these outcomes was less certain, particularly that on withdrawals due to adverse events. However, the studies do suggest more people dropped out of the trials because of drug-related harms in the lower target group.
In summary, in people with hypertension and established cardiovascular disease, the currently available randomized trials do not support intensive treatment to achieve lower blood pressure targets as compared to standard blood pressure targets. This was consistent in our predefined subgroup analyses by age, sex or presence of diabetes, and we did not identify any population subgroup that benefited from intensive treatment. Thus, according to the best available evidence, lower targets for people with hypertension and established cardiovascular disease provide minimal or no net health benefit. However, well‐designed randomized trials are still needed to more clearly determine the benefits (especially with regard to the 'total cardiovascular events' outcome) and the harms derived from intensive versus more conservative strategies.
Mike: If you would like to find out more about the included studies and the use of individual participant data in this update of the review, and watch for the next update, it's available online at Cochrane Library dot com with a search for 'blood pressure targets and cardiovascular disease'.