Archief Roodbont

Benefits of extra BP lowering disputed

17 July 2009

MedWire News: Researchers claim lowering blood pressure (BP) beyond standard targets is not beneficial to any hypertensive patient, after conducting a review of seven trials involving more than 22,000 participants.

Lowering BP beyond standard targets neither prolonged survival nor reduced the risk fora range of cardiovascular outcomes, they report in the Cochrane Database of Systematic Reviews.

Jose Agustin Arguedas (University of Costa Rica, San Pedro de Montes de Oca) initially searched for trials comparing different systolic BP targets but could not find any.

However, they did identify seven trials, including 22,089 individuals, which compared different diastolic BP targets.

Attempting to achieve lower targets of 135/85 mmHg or less led to a significantly greater BP reduction of 4 mmHg systolic and 3 mmHg diastolic compared with standard targets of 140–160 mmHg systolic and 90–100 mmHg diastolic.

However, this did not significantly affect the relative risk for total mortality, myocardial infarction, stroke, congestive heart failure, major cardiovascular , or end-stage renal disease.

The researchers acknowledge that the net health effect of lower targets cannot be fully assessed due to a lack of information on all serious adverse events and withdrawals due to adverse effects in six of the seven trials.

A sensitivity analysis in patients with diabetes and those with chronic renal disease also did not show a reduction in any of the mortality and morbidity outcomes with lower targets.

The researchers conclude: “More trials are needed, but at present there is no evidence to support aiming for a [BP] target lower than 140/90 mmHg in any hypertensive patient.”

However, they add: “Because guidelines are recommending even lower targets for diabetes mellitus and chronic renal disease, we are currently conducting systematic reviews in those groups of patients.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Cochrane Database Syst Rev 2009; 3: CD004349