A systematic review and network meta-analysis, which allowed the simultaneous comparison of multiple achieved systolic blood pressure (SBP) levels on clinical outcomes while preserving trial-level treatment randomization, indicates that treating patients to reduce SBP below currently recommended targets may significantly reduce risk of cardiovascular disease (CVD) and all-cause mortality, with the lowest risk at a SBP of 120 to 124 mm Hg. The study included 144 220 patients from 42 trials. In general, there were linear associations between mean achieved SBP and risk of CVD and mortality, with the lowest risk at 120 to 124 mm Hg. Randomized groups with a mean achieved SBP of 120 to 124 mm Hg had a hazard ratio (HR) for major CVD of 0.71, 0.58, 0.46 and 0.36, respectively, compared with randomized groups with a mean achieved SBP of 130 to 134 mm Hg, 140 to 144 mm Hg, 150 to 154 mm Hg, and 160 mm Hg or more. Likewise, randomized groups with a mean achieved SBP of 120 to 124 mm Hg had an HR for all-cause mortality of 0.73, 0.59, 0.51 and 0.47, respectively, compared with randomized groups with a mean achieved SBP of 130 to 134 mm Hg, 140 to 144 mm Hg, 150 to 154 mm Hg, and 160 mm Hg or more. The findings support more intensive control of SBP among adults with hypertension. Source: http://jamanetwork.com/http://jamanetwork.com/
