Optimal Systolic Blood Pressure Target After SPRINT: Insights from a Network Meta-Analysis of Randomized Trials

Bangalore, Sripal; Toklu, Bora; Gianos, Eugenia; Schwartzbard, Arthur; Weintraub, Howard; Ogedegbe, Gbenga; Messerli, Franz H.

doi:10.1016/j.amjmed.2017.01.004

Cited by 146 publications

(82 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In 2007, an National Heart, Lung, and Blood Institute expert panel concluded that it would be important to test the hypothesis that a lower systolic BP goal could reduce clinical events more than a standard BP reduction goal. Several large recent RCTs sought to answer that question by selecting systolic BP treatment targets of <120 mm Hg (49,61,63,64) or <130 mm Hg (48,(56)(57)(58)(59)(60)62). The results of our meta-analysis have shown that BP lowering to a target of <130 mm Hg may significantly reduce the risk of several important outcomes.…”

Section: Sensitivity Analysesmentioning

confidence: 78%

“…Publication dates ranged from 1998 through 2015. Target BPs varied for the lower and standard BP groups with 9 studies having a systolic BP target <130 mm Hg for the lower therapy group (48,49,(56)(57)(58)(59)(60)(61)(62)(63)(64). Many of the studies included patients with comorbid conditions such as diabetes mellitus, CKD, or were at high risk for cardiovascular disease or progression to end-stage renal disease.…”

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Reboussin¹,

Allen²,

Griswold³

et al. 2018

Hypertension

146

View full text Add to dashboard Cite

These members of the evidence review committee are listed alphabetically, and all participated equally in the process. †The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. ‡Former Task Force member; current member during the writing effort. Copies: This document is available on the websites of the American College of Cardiology (www.acc.org) and the American Heart Association (professional.heart.org). A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Expert peer review of AHA Scientific Statements is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://professional.heart.org/statements. Select the "Guidelines & Statements" drop-down menu, then click "Publication Development."Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright-Permission-Guidelines_UCM_300404_Article.jsp. A link to the "Copyright Permissions Request Form" appears on the right side of the page. With Hypertension .................................................................................................................................. 7 Introduction: Part 1 ............................................................................................................................ 1 ................................................................................................................................. 1 ....................................................................................................................... 1 .................................................................................................................................... ........................................................................................................................ 2 ................................................................................................................................ 2 ................................................................................................................................... ............................................................................................................................. ...................................................................................................................... 33 References ........................................................................................................................................ AbstractObjective: To review the literature systematically and perform meta-analyses to ...

show abstract

Section: Sensitivity Analysesmentioning

confidence: 78%

Section: Study Characteristicsmentioning

confidence: 99%

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Reboussin¹,

Allen²,

Griswold³

et al. 2018

Hypertension

146

View full text Add to dashboard Cite

show abstract

“…In a network meta-analysis by Bundy and coworkers, a mean achieved systolic BP 120–124 mm Hg was associated with a significant reduction in the risk of cardiovascular disease and all-cause mortality even in the comparison with achieved systolic BP levels 125–129 mm Hg 31. Bangalore and coworkers published a network meta-analysis of trials designed to compare different BP targets and concluded that systolic BP targets <120 mm Hg and <130 mm Hg ranked number 1 and number 2, respectively, as the most efficacious for preventing stroke and myocardial infarction 32. Conversely, systolic BP targets <140 mm Hg and <150 mm Hg ranked as number 1 and number 2, respectively, for safety.…”

Section: Discussionmentioning

confidence: 99%

Managing hypertension in 2018: which guideline to follow?

et al. 2019

View full text Add to dashboard Cite

Hypertension is a global public health issue and a major cause of morbidity and mortality. Its prevalence is increasing in many Asian countries, with a number of countries with blood pressure above the global average. Although the average systolic blood pressure is decreasing worldwide since the 1980s at the rate of about 1 mm Hg systolic blood pressure per decade, it is increasing in low-income and middle-income countries, especially in the East and South Asian population. Of note, the much larger base Asian population results in a considerably larger absolute number of individuals affected. When compared with Western countries, hypertension among Asian populations has unique features in terms of its onset, clustering of associated cardiovascular risk factors, complications and outcomes. Moreover, only a minority of hypertensive individuals are receiving treatment and achieving control. Projected number of deaths related to hypertension dramatically increased in the last 25 years in some Asian regions with a disproportionately high mortality and morbidity from stroke compared with Western countries. The relation between blood pressure and the risk of stroke is stronger in Asia than in Western regions. Although new Guidelines for hypertension diagnosis and management have been recently released from Europe and North America, the unique features of Asian hypertensive patients raise concerns on the clinical applicability of Western Guidelines to Asian populations. To this purpose, we critically reviewed key elements from the most updated Guidelines. We also discussed their core concepts to verify the impact on hypertension prevention and management in Asian countries.

show abstract

“…Meta-analyses of randomized controlled trials have suggested that lowering BP to <120 mm Hg does not increase CVD or mortality risk (84–86). However, there may be little benefit associated with lowering SBP much below 120 mm Hg (85). Considering both observational and randomized controlled trial data, it would be hard to justify prescribing or intensifying antihypertensive medication for people with SBP <120 mm Hg or DBP <60 mm Hg, regardless of their global CVD risk.…”

Section: Unanswered Questionsmentioning

confidence: 99%

Using Predicted Cardiovascular Disease Risk in Conjunction With Blood Pressure to Guide Antihypertensive Medication Treatment

Muntner

Whelton

2017

Journal of the American College of Cardiology

View full text Add to dashboard Cite

Using cardiovascular disease (CVD) risk instead of, or in addition to, blood pressure (BP) to guide antihypertensive treatment is an active area of research. The purpose of this review is to provide an overview of studies that may inform this treatment paradigm. We review data from randomized trials on relative and absolute CVD risk reduction that may occur when antihypertensive treatment is guided by CVD risk. We review population-level data on using CVD risk in conjunction with BP for guiding antihypertensive treatment, the broad distribution in CVD risk for people with similar BP levels, and the use of CVD risk for guiding antihypertensive treatment among sub-groups including older adults, young adults and those with diabetes or chronic kidney disease. Also, we review potential challenges in implementing antihypertensive treatment recommendations that incorporate CVD risk. In closing, we provide recommendations for using CVD risk in combination with BP to guide antihypertensive treatment.

show abstract

Optimal Systolic Blood Pressure Target After SPRINT: Insights from a Network Meta-Analysis of Randomized Trials

Abstract: In patients with hypertension, a on-treatment systolic BP target of <130 mm Hg achieved optimal balance between efficacy and safety.

Cited by 146 publications

References 41 publications

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Managing hypertension in 2018: which guideline to follow?

Using Predicted Cardiovascular Disease Risk in Conjunction With Blood Pressure to Guide Antihypertensive Medication Treatment

Contact Info

Product

Resources

About