Intensive Blood-Pressure Lowering Improves Outcomes

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Intensive Blood-Pressure Lowering Improves Outcomes


Intensive blood-pressure reduction below currently recommended targets provides greater vascular protection, particularly for people at high risk for cardiovascular outcomes, the results of a new systemic review and meta-analysis suggest.
The findings were published online November 6 in the Lancet by Dr Xinfang Xie, of the renal division, department of medicine, Peking University First Hospital, Beijing, China, and colleagues.
The review, of 19 trials involving nearly 45,000 participants, showed that intensive blood-pressure lowering achieved in the trials significantly reduced major cardiovascular events (composite), stroke, myocardial infarction (MI), albuminuria, and retinopathy progression, but had no impact on heart failure, cardiovascular death, total mortality, or end-stage kidney disease compared with less intensive regimens.
The new data call into question the recent loosening of blood-pressure targets for some high-risk populations in recent guidelines from the Eighth Joint National Committee (JNC8) and the European Society of Cardiology/European Society of Hypertension among others, Xie and colleagues say.
“This review and meta-analysis provides clear evidence of the benefits of more intensive blood-pressure lowering, including in high-risk patients whose systolic blood pressure is lower than 140 mm Hg. Existing clinical guidelines should be revised accordingly, to recommend more intensive blood-pressure–lowering treatment in high-risk patient groups,” the authors write.

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