Intensive versus Usual Control of Hypertension in the Prevention of Cardiovascular and Renal Outcomes: A Cumulative Meta-Analysis of Randomized Controlled Trials.

BACKGROUND/AIMS: Previous studies have reported inconsistent results regarding the treatment effects of intensive blood pressure (IBP) control in the prevention of cardiovascular and renal outcomes. We conducted this cumulative meta-analysis to evaluate the treatment effects of IBP control on cardiovascular and renal outcomes.

METHODS

We systematically searched PubMed, EMBASE, and the Cochrane Library databases from the date of their inception to October 2017, to identify randomized controlled trials (RCTs). The relative risks (RRs) with corresponding 95% confidence intervals (CIs) were used to evaluate the treatment effects of IBP control by using a random-effects model.

RESULTS

The final analysis included 20 RCTs involving 56,687 individuals. The summary RRs indicated that IBP control treatment significantly reduced the risk of major cardiovascular events (RR: 0.85; 95% CI: 0.77-0.94; p = 0.001), including myocardial infarction (RR: 0.87; 95% CI: 0.76-1.00; p = 0.044), stroke (RR: 0.77; 95% CI: 0.66-0.89; p < 0.001), and albuminuria (RR: 0.90; 95% CI: 0.84-0.97; p = 0.007). However, IBP control had no significant effect on heart failure (RR: 0.80; 95% CI: 0.62-1.03; p = 0.077), all-cause mortality (RR: 0.91; 95% CI: 0.81-1.02; p = 0.112), cardiac death (RR: 0.91; 95% CI: 0.75-1.12; p = 0.390), non-cardiac death (RR: 0.98; 95% CI: 0.86-1.12; p = 0.773), end-stage renal disease (RR: 0.90; 95% CI: 0.77-1.06; p = 0.203), and retinopathy (RR: 0.81; 95% CI: 0.66-1.00; p = 0.052).

CONCLUSION

The findings of this study suggest that IBP control plays a beneficial role in the prevention of some major cardiovascular events, including myocardial infarction, stroke, and albuminuria.