The optimal blood pressure(BP) target has been a matter of debate. The recent SPRINT trial showed significant benefits of a BP target of <120 mmHg albeit with an increase in serious adverse effects (SAE).Design and method:
PUBMED/EMBASE/CENTRAL were searched for randomized trials comparing treating to different BP targets. Trial arms were grouped into five systolic BP target categories: 1) <160 mmHg; 2) <150 mmHg; 3) <140 mmHg; 4) <130 mmHg and 5) <120 mmHg. Efficacy outcomes of stroke, myocardial infarction, death, cardiovascular death, heart failure and safety outcomes of SAE were evaluated using a network meta-analysis.Results:
Seventeen trials that enrolled 55,163 patients with 204,103 patient-years of follow-up were included. There was a significant decrease in stroke (RR = 0.54; 95% CI 0.29–1.00) and myocardial infarction with systolic BP <120 mmHg (vs. <160 mmHg) (RR = 0.68; 95% CI 0.47–1.00). Sensitivity analysis using achieved systolic BP showed a 72%, 97% and 227% increase in stroke with systolic BP of <140 mmHg, <150 mmHg and <160 mm when compared with systolic BP <120 mmHg. There was no difference in death, cardiovascular death or heart failure when comparing any of the BP targets. However, the point estimate favored lower BP targets (<120 mmHg, <130 mmHg) when compared with higher BP targets (<140 mmHg or <150 mmHg). BP targets of <120 mmHg and <130 mmHg ranked #1 and #2 as the most efficacious target. There was a significant increase in SAE with systolic BP <120 mmHg vs. <150 mmHg (RR = 1.83; 95% CI 1.05–3.20) or vs. <140 mmHg (RR = 2.12; 95% CI 1.46–3.08). BP targets of <140 mmHg and <150 mmHg ranked #1 and #2 as the safest target for the outcome of SAE. Cluster plots for combined efficacy and safety showed that a systolic BP target of <130 mmHg had optimal balance between efficacy and safety.Conclusions:
Among patients with cardiovascular disease, a systolic BP target of <130 mmHg achieved optimal balance between efficacy and safety.