Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W., S.O.C., K.T.M., J.H.).
Department of Medicine, Tulane University School of Medicine, New Orleans, LA (P.K.W., J.H.).
Hypertension. 2024 Nov;81(11):2329-2339. doi: 10.1161/HYPERTENSIONAHA.124.23597. Epub 2024 Sep 12.
Systolic blood pressure (SBP) lowering reduces major cardiovascular disease (CVD) and all-cause mortality. However, the optimal target for SBP lowering remains controversial.
We included trials with random allocation to an SBP <130 mm Hg treatment target and CVD as the primary outcome. Data were extracted from each study independently and in duplicate using a standardized protocol. Random-effects meta-analysis was used to obtain pooled hazard ratios (HRs) and 95% CIs for CVD and all-cause mortality comparing SBP <130 and ≥130 mm Hg treatment targets. A secondary analysis compared the same outcomes for randomization to an SBP target of <120 or <140 mm Hg.
Seven trials, including 72 138 participants, met the eligibility criteria. Compared with an SBP target of ≥130 mm Hg, an SBP target of <130 mm Hg significantly reduced major CVD (HR, 0.78 [95% CI, 0.70-0.87]) and all-cause mortality (HR, 0.89 [95% CI, 0.79-0.99]). Compared with an SBP target of <140 mm Hg, an intensive SBP target of <120 mm Hg significantly reduced major CVD (HR, 0.82 [95% CI, 0.74-0.91]), but all-cause mortality was marginally insignificant (HR, 0.85 [95% CI, 0.71-1.01]). Adverse events were significantly more likely in the intensive SBP target groups, but the absolute risks were low.
This study suggests targeting an SBP <130 mm Hg significantly reduces the risks of major CVD and all-cause mortality. The findings also support an SBP target of <120 mm Hg, based on a smaller number of trials.
URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023490693.
收缩压（SBP）降低可降低主要心血管疾病（CVD）和全因死亡率。然而，SBP 降低的最佳目标仍存在争议。
我们纳入了随机分配至 SBP<130mmHg 治疗目标且 CVD 为主要结局的试验。使用标准化方案独立且重复地从每项研究中提取数据。使用随机效应荟萃分析获得比较 SBP<130 和≥130mmHg 治疗目标的 CVD 和全因死亡率的汇总风险比（HR）和 95%置信区间（CI）。次要分析比较了 SBP 目标值<120 或<140mmHg 的随机分组的相同结局。
有 7 项试验，共 72138 名参与者符合入选标准。与 SBP≥130mmHg 目标值相比，SBP<130mmHg 目标值显著降低主要 CVD（HR，0.78[95%CI，0.70-0.87]）和全因死亡率（HR，0.89[95%CI，0.79-0.99]）。与 SBP<140mmHg 目标值相比，强化 SBP<120mmHg 目标值显著降低主要 CVD（HR，0.82[95%CI，0.74-0.91]），但全因死亡率略有统计学意义（HR，0.85[95%CI，0.71-1.01]）。强化 SBP 目标组发生不良事件的可能性显著增加，但绝对风险较低。
本研究表明，将 SBP 目标值<130mmHg 可显著降低主要 CVD 和全因死亡率的风险。基于试验数量较少，研究结果也支持 SBP<120mmHg 的目标值。
网址：https://www.crd.york.ac.uk/PROSPERO/；唯一标识符：CRD42023490693。
