Effects of intensive blood pressure on lowering cardiovascular and renal outcomes

This study analyzed data collected from previous trials involving different blood pressure reduction practices to reduce risk of major cardiovascular and renal events to determine which strategies were most effective. The study looked at data from different trials using more intensive blood pressure reduction, such as stricter target blood pressures or antihypertension medication dosing regimens, versus less strict treatment guidelines. The risk of cardiovascular or renal events looked at were myocardial infarctions, stroke, cardiovascular failure, and end-stage kidney diseases.

The study found that ultimately, the more intensive hypertension treatments are more beneficial than the less intensive ones to all populations, including patients with systolic blood pressure under 140 mmHg. 19 trials with 44989 participants were included in that data analysis, with 2496 major cardiovascular events in a 3-8 year range. The patients that underwent more intensive treatments had a mean blood pressure of 133/76 mmHg, while those with less intensive treatments had a mean blood pressure of 140/81 mmHg. The patients with intensive blood pressure treatments had 14% decreased chance of major cardiovascular events, though didn’t seem to have conclusively less risk of total mortality or end-stage kidney disease.

Management of hypertension is becoming a very important subject within the field of pharmacy, especially since an increasing percentage of the population are struggling with lowering blood pressure. It’s interesting to see a comparison of the efficacy of different antihypertensive practices within different patient populations as we have recently discussed these very guidelines in class. One question that this article raises is why are blood pressure guidelines becoming less stringent, and why are less intensive blood pressure treatments not being used as much in higher-risk patient populations?

Citation:

Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016; 387: 435-43.

http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(15)00805-3.pdf