Bruce Soloway, MD reviewing Böhm M et al. Lancet 2017 Apr 5.

In two trials, achieved systolic BP <120 mm Hg was associated with greater CV-related and all-cause mortality.

Optimal target blood pressure (BP) for patients who are receiving antihypertensive therapy remains controversial; numerous studies have suggested that excessive BP lowering can increase risk for some adverse cardiovascular (CV) events. However, in the SPRINT trial, targeting a systolic BP of <120 mm Hg lowered the incidence of adverse CV events more than did less-aggressive treatment, although average achieved systolic BP actually remained slightly higher than 120 mm Hg (NEJM JW Gen Med Dec 15 2015 and N Engl J Med 2015; 373:2174). To elucidate further the relation between BP and adverse CV outcomes, researchers analyzed pooled data from 31,000 high-risk patients (age, ≥55; history of CV disease or diabetes with organ damage; 70% with hypertension) who were assigned to take ramipril, telmisartan, both, or neither for a median 56 months in two trials funded by the manufacturer of telmisartan. Outcomes included a composite endpoint (CV-related death, myocardial infarction, stroke, or hospitalization for heart failure), individual CV endpoints, and all-cause death.

Mean BP achieved on treatment was a stronger predictor of CV outcomes than was baseline BP or last recorded BP before an adverse CV event. For most outcomes, risk was lowest at mean achieved systolic and diastolic BPs of 120 to 140 mm Hg and 70 to 80 mm Hg, respectively. The composite outcome, CV-related death, heart failure hospitalization, and all-cause death all occurred significantly more commonly at lower systolic BPs, and all outcomes except stroke were more frequent at lower diastolic BPs.

CITATION(S):

Böhm M et al. Achieved blood pressure and cardiovascular outcomes in high-risk patients: Results from ONTARGET and TRANSCEND trials. Lancet 2017 Apr 5; [e-pub].

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