| مستخلص: |
Question What are the efficacy and safety of lower systolic blood pressure (BP) targets compared with a target of <160 mm Hg? Review scope Included studies compared different systolic, diastolic, or mean arterial BP targets and reported ≥1 of stroke, myocardial infarction (MI), all-cause or cardiovascular mortality, heart failure, or serious adverse events (SAEs). Review methods MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Registry of Controlled Trials (CENTRAL), and reference lists were searched for randomized controlled trials (RCTs). 17 RCTs (n=55163, mean age 41 to 77 y, 37% to 75% men) with mean follow-up of 3.7 years met the selection criteria. 2 trials reported adequate allocation concealment, and 15 reported adequate blinding. Main results Network meta-analysis found that, compared with a systolic BP target <160 mm Hg, a target <120 mm Hg showed a borderline reduction in stroke and MI, and targets <150 and <140 mm Hg reduced risk for SAEs; no other target reduced any outcome (Table). Comparisons between other targets showed that a target of <120 mm Hg increased risk for serious adverse events compared with targets <150 mm Hg (relative risk [RR] 1.83, 95% CI 1.05 to 3.20) and <140 mm Hg (RR 2.12, CI 1.46 to 3.08); other targets did not differ from one another for any outcome. Conclusion Compared with a systolic blood pressure target of <160 mm Hg, a target of <120 mm Hg may reduce stroke and myocardial infarction, and targets of <150 mm Hg and <140 mm Hg reduce serious adverse events. [ABSTRACT FROM AUTHOR] |
