Sunday, September 27, 2009

Perspective: aggressive blood pressure lowering is of uncertain benefit

A short ‘News and Perspectives’ piece in JAMA discusses a recently released Cochrane Review that found no evidence to support aggressive blood pressure lowering.

The Review aimed to determine whether aggressive blood pressure targets (≤ 135/85 mmHg) improved clinical outcomes (mortality and serious morbidity) any more than standard targets (≤ 140-160/ 90-100 mmHg). Its authors found no trials comparing systolic targets and seven trials (n=22,089) comparing diastolic targets; primary outcomes for the review were total mortality; total serious adverse events; total cardiovascular events; myocardial infarction, stroke, congestive heart failure and end stage renal disease.

The analysis found that although BP was lower in groups treated to more aggressive targets, there was no significant benefit in any of the outcome measures studied. Because only one trial reported serious adverse effects and withdrawals, the net health effects of aggressive targets could not be assessed. Subgroup analysis in patients with diabetes and patients with chronic renal disease also found no significant benefit: as guidelines are recommending lower targets still for these patients, the authors are currently conducting systematic reviews in these specific patients.

The JAMA article notes that two major guidelines on hypertension treatment are currently under review (European and US), and quotes members of the respective review committees on the new evidence. It also notes that two clinical trials in progress may help to answer some of the questions raised by the review.

JAMA 2009; 302: 1047-8 (link to extract);
Cochrane Review: Cochrane Database Syst Rev. 2009;3:CD004349 (link to abstract)

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