Advantage of lowering systolic blood pressure to <120 mm Hg vs <140 mm Hg

<h2 id="aim">Aim:</h2><p>This first and largest randomised study aimed to analyse if lowering systolic blood pressure (SBP) to less than 120 mm Hg is superior to that of less than 140 mm Hg, in patients with diabetes and patients with previous stroke.</p><h2 id="methods">Methods:</h2><ul><li>Open-label, blinded-outcome, randomised controlled trial, included before participants with high cardio-vascular risk from 116 hospitals or communities.</li><li>Participants assigned to intensive treatment targeting standard office SBP &lt; 120 mm Hg or standard treatment targeting &lt; 140 mm Hg.</li><li>1255 participants (4359 with diabetes and 3022 with previous stroke) were analysed between Sept 17, 2019, and July 13, 2020.</li><li>Patients were assigned to intensive treatment (n=5624) or standard treatment (n=5631) with mean age of 64-6 years (SD 7-1).</li><li>Primary outcome: Composite of myocardial infarction, revascularisation, hospitalisation for heart failure, stroke, or death from cardiovascular causes, assessed by the intention-to-treat principle.</li></ul><h2 id="results">Results:</h2><p>The mean SBP and duration of stable SBP was 119-1 mm Hg (SD 11-1), 9 months in the intensive treatment group and 134-8 mm Hg (SD 10-5), 2 months in the standard treatment group (fig. 1).</p><figure class="image"><img style="aspect-ratio:643/433;" src="https://cdn.megawecare.com/GHBY/Internal-Images/systolic-blood-pressure-01.webp" width="643" height="433"></figure><ul><li>Primary outcome event occurred in 547 (9-:7%) participants in the intensive treatment group and 623 (11-1%) in the standard treatment group (hazard ratio [HR] 0-88, p=0-028) during a median of 3-4 years (fig. 2A and B).</li></ul><figure class="image"><img style="aspect-ratio:655/531;" src="https://cdn.megawecare.com/GHBY/Internal-Images/primary-outcoume-02.webp" width="655" height="531"></figure><ul><li>No heterogeneity of effects by diabetes status, duration of diabetes, or history of stroke was observed.</li><li>Serious adverse events of syncope occurred more frequently in the intensive treatment group (0-4%) than in standard treatment group (0:1%; HR 3-00).</li><li>No significant between-group difference in the serious adverse events of hypotension, electrolyte abnormality, injurious fall, or acute kidney injury was observed.</li></ul><h2 id="conclusion">Conclusion</h2><ul><li>For hypertensive patients at high cardiovascular risk, regardless of the status of diabetes or history of stroke, the treatment strategy of targeting SBP of less than 120 mm Hg, as compared with that of less than 140 mm Hg, prevents major vascular events, with minor excess risk.</li><li>Study showed no heterogeneity of effects by diabetes status, duration of diabetes, or history of stroke with fewer acute harm events than previous trials.</li><li>A lower blood pressure target (i.e., standard office systolic blood pressure &lt;120 mm Hg) should be considered for patients with high cardiovascular risk, regardless of diabetes status or history of stroke.</li></ul>

Cardiology Update Issue 4 July 2024

<ul><li><a href="#aim">Aim</a></li><li><a href="#methods">Methods</a></li><li><a href="#results">Results</a></li><li><a href="#conclusion">Conclusion</a></li></ul>