Optimal Systolic Blood Pressure Target After SPRINT: Insights from a Network Meta-Analysis of Randomized Trials

Optimal Systolic Blood Pressure Target After SPRINT: Insights from a Network Meta-Analysis of Randomized Trials. Bangalore, S., Toklu, B., Gianos, E., Schwartzbard, A., Weintraub, H., Ogedegbe, G., & Messerli, F. H. The American Journal of Medicine, 130(6):707–719.e8, June, 2017.

Paper doi abstract bibtex

BACKGROUND: The optimal on-treatment blood pressure (BP) target has been a matter of debate. The recent SPRINT trial showed signiﬁcant beneﬁts of a BP target of \textless120 mm Hg, albeit with an increase in serious adverse effects related to low BP. METHODS: PubMed, EMBASE, and CENTRAL were searched for randomized trials comparing treating with different BP targets. Trial arms were grouped into 5 systolic BP target categories: 1) \textless160 mm Hg, 2) \textless150 mm Hg, 3) \textless140 mm Hg, 4) \textless130 mm Hg, and 5) \textless120 mm Hg. Efﬁcacy outcomes of stroke, myocardial infarction, death, cardiovascular death, heart failure, and safety outcomes of serious adverse effects 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 (rate ratio [RR] 0.54; 95% conﬁdence interval [CI], 0.29-1.00) and myocardial infarction (RR 0.68; 95% CI, 0.47-1.00) with systolic BP \textless120 mm Hg (vs \textless160 mm Hg). Sensitivity analysis using achieved systolic BP showed a 72%, 97%, and 227% increase in stroke with systolic BP of \textless140 mm Hg, \textless150 mm Hg, and \textless160 mm, respectively, when compared with systolic BP \textless120 mm Hg. 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 (\textless120 mm Hg, \textless130 mm Hg) when compared with higher BP targets (\textless140 mm Hg or \textless150 mm Hg). BP targets of \textless120 mm Hg and \textless130 mm Hg ranked #1 and #2, respectively, as the most efﬁcacious target. There was a signiﬁcant increase in serious adverse effects with systolic BP \textless120 mm Hg vs \textless150 mm Hg (RR 1.83; 95% CI, 1.05-3.20) or vs \textless140 mm Hg (RR 2.12; 95% CI, 1.46-3.08). BP targets of \textless140 mm Hg and \textless150 mm Hg ranked #1 and #2, respectively, as the safest target for the outcome of serious adverse effects. Cluster plots for combined efﬁcacy and safety showed that a systolic BP target of \textless130 mm Hg had optimal balance between efﬁcacy and safety. CONCLUSIONS: In patients with hypertension, a on-treatment systolic BP target of \textless130 mm Hg achieved optimal balance between efﬁcacy and safety. Ó 2017 Elsevier Inc. All rights reserved. The American Journal of Medicine (2017) 130, 707-719

@article{bangalore_optimal_2017-1,
	title = {Optimal {Systolic} {Blood} {Pressure} {Target} {After} {SPRINT}: {Insights} from a {Network} {Meta}-{Analysis} of {Randomized} {Trials}},
	volume = {130},
	issn = {00029343},
	shorttitle = {Optimal {Systolic} {Blood} {Pressure} {Target} {After} {SPRINT}},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S0002934317300359},
	doi = {10.1016/j.amjmed.2017.01.004},
	abstract = {BACKGROUND: The optimal on-treatment blood pressure (BP) target has been a matter of debate. The recent SPRINT trial showed signiﬁcant beneﬁts of a BP target of {\textbackslash}textless120 mm Hg, albeit with an increase in serious adverse effects related to low BP. METHODS: PubMed, EMBASE, and CENTRAL were searched for randomized trials comparing treating with different BP targets. Trial arms were grouped into 5 systolic BP target categories: 1) {\textbackslash}textless160 mm Hg, 2) {\textbackslash}textless150 mm Hg, 3) {\textbackslash}textless140 mm Hg, 4) {\textbackslash}textless130 mm Hg, and 5) {\textbackslash}textless120 mm Hg. Efﬁcacy outcomes of stroke, myocardial infarction, death, cardiovascular death, heart failure, and safety outcomes of serious adverse effects 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 (rate ratio [RR] 0.54; 95\% conﬁdence interval [CI], 0.29-1.00) and myocardial infarction (RR 0.68; 95\% CI, 0.47-1.00) with systolic BP {\textbackslash}textless120 mm Hg (vs {\textbackslash}textless160 mm Hg). Sensitivity analysis using achieved systolic BP showed a 72\%, 97\%, and 227\% increase in stroke with systolic BP of {\textbackslash}textless140 mm Hg, {\textbackslash}textless150 mm Hg, and {\textbackslash}textless160 mm, respectively, when compared with systolic BP {\textbackslash}textless120 mm Hg. 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 ({\textbackslash}textless120 mm Hg, {\textbackslash}textless130 mm Hg) when compared with higher BP targets ({\textbackslash}textless140 mm Hg or {\textbackslash}textless150 mm Hg). BP targets of {\textbackslash}textless120 mm Hg and {\textbackslash}textless130 mm Hg ranked \#1 and \#2, respectively, as the most efﬁcacious target. There was a signiﬁcant increase in serious adverse effects with systolic BP {\textbackslash}textless120 mm Hg vs {\textbackslash}textless150 mm Hg (RR 1.83; 95\% CI, 1.05-3.20) or vs {\textbackslash}textless140 mm Hg (RR 2.12; 95\% CI, 1.46-3.08). BP targets of {\textbackslash}textless140 mm Hg and {\textbackslash}textless150 mm Hg ranked \#1 and \#2, respectively, as the safest target for the outcome of serious adverse effects. Cluster plots for combined efﬁcacy and safety showed that a systolic BP target of {\textbackslash}textless130 mm Hg had optimal balance between efﬁcacy and safety. CONCLUSIONS: In patients with hypertension, a on-treatment systolic BP target of {\textbackslash}textless130 mm Hg achieved optimal balance between efﬁcacy and safety. Ó 2017 Elsevier Inc. All rights reserved. The American Journal of Medicine (2017) 130, 707-719},
	language = {en},
	number = {6},
	urldate = {2019-05-02},
	journal = {The American Journal of Medicine},
	author = {Bangalore, Sripal and Toklu, Bora and Gianos, Eugenia and Schwartzbard, Arthur and Weintraub, Howard and Ogedegbe, Gbenga and Messerli, Franz H.},
	month = jun,
	year = {2017},
	pages = {707--719.e8},
	file = {Bangalore et al. - 2017 - Optimal Systolic Blood Pressure Target After SPRIN.pdf:/Users/neil.hawkins/Zotero/storage/T45FJ7W8/Bangalore et al. - 2017 - Optimal Systolic Blood Pressure Target After SPRIN.pdf:application/pdf},
}

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METHODS: PubMed, EMBASE, and CENTRAL were searched for randomized trials comparing treating with different BP targets. Trial arms were grouped into 5 systolic BP target categories: 1) \\textless160 mm Hg, 2) \\textless150 mm Hg, 3) \\textless140 mm Hg, 4) \\textless130 mm Hg, and 5) \\textless120 mm Hg. Efﬁcacy outcomes of stroke, myocardial infarction, death, cardiovascular death, heart failure, and safety outcomes of serious adverse effects 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 (rate ratio [RR] 0.54; 95% conﬁdence interval [CI], 0.29-1.00) and myocardial infarction (RR 0.68; 95% CI, 0.47-1.00) with systolic BP \\textless120 mm Hg (vs \\textless160 mm Hg). Sensitivity analysis using achieved systolic BP showed a 72%, 97%, and 227% increase in stroke with systolic BP of \\textless140 mm Hg, \\textless150 mm Hg, and \\textless160 mm, respectively, when compared with systolic BP \\textless120 mm Hg. 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 (\\textless120 mm Hg, \\textless130 mm Hg) when compared with higher BP targets (\\textless140 mm Hg or \\textless150 mm Hg). BP targets of \\textless120 mm Hg and \\textless130 mm Hg ranked #1 and #2, respectively, as the most efﬁcacious target. There was a signiﬁcant increase in serious adverse effects with systolic BP \\textless120 mm Hg vs \\textless150 mm Hg (RR 1.83; 95% CI, 1.05-3.20) or vs \\textless140 mm Hg (RR 2.12; 95% CI, 1.46-3.08). BP targets of \\textless140 mm Hg and \\textless150 mm Hg ranked #1 and #2, respectively, as the safest target for the outcome of serious adverse effects. Cluster plots for combined efﬁcacy and safety showed that a systolic BP target of \\textless130 mm Hg had optimal balance between efﬁcacy and safety. CONCLUSIONS: In patients with hypertension, a on-treatment systolic BP target of \\textless130 mm Hg achieved optimal balance between efﬁcacy and safety. Ó 2017 Elsevier Inc. All rights reserved. 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The recent SPRINT trial showed signiﬁcant beneﬁts of a BP target of {\\textbackslash}textless120 mm Hg, albeit with an increase in serious adverse effects related to low BP. METHODS: PubMed, EMBASE, and CENTRAL were searched for randomized trials comparing treating with different BP targets. Trial arms were grouped into 5 systolic BP target categories: 1) {\\textbackslash}textless160 mm Hg, 2) {\\textbackslash}textless150 mm Hg, 3) {\\textbackslash}textless140 mm Hg, 4) {\\textbackslash}textless130 mm Hg, and 5) {\\textbackslash}textless120 mm Hg. Efﬁcacy outcomes of stroke, myocardial infarction, death, cardiovascular death, heart failure, and safety outcomes of serious adverse effects 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 (rate ratio [RR] 0.54; 95\\% conﬁdence interval [CI], 0.29-1.00) and myocardial infarction (RR 0.68; 95\\% CI, 0.47-1.00) with systolic BP {\\textbackslash}textless120 mm Hg (vs {\\textbackslash}textless160 mm Hg). Sensitivity analysis using achieved systolic BP showed a 72\\%, 97\\%, and 227\\% increase in stroke with systolic BP of {\\textbackslash}textless140 mm Hg, {\\textbackslash}textless150 mm Hg, and {\\textbackslash}textless160 mm, respectively, when compared with systolic BP {\\textbackslash}textless120 mm Hg. 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 ({\\textbackslash}textless120 mm Hg, {\\textbackslash}textless130 mm Hg) when compared with higher BP targets ({\\textbackslash}textless140 mm Hg or {\\textbackslash}textless150 mm Hg). BP targets of {\\textbackslash}textless120 mm Hg and {\\textbackslash}textless130 mm Hg ranked \\#1 and \\#2, respectively, as the most efﬁcacious target. There was a signiﬁcant increase in serious adverse effects with systolic BP {\\textbackslash}textless120 mm Hg vs {\\textbackslash}textless150 mm Hg (RR 1.83; 95\\% CI, 1.05-3.20) or vs {\\textbackslash}textless140 mm Hg (RR 2.12; 95\\% CI, 1.46-3.08). BP targets of {\\textbackslash}textless140 mm Hg and {\\textbackslash}textless150 mm Hg ranked \\#1 and \\#2, respectively, as the safest target for the outcome of serious adverse effects. Cluster plots for combined efﬁcacy and safety showed that a systolic BP target of {\\textbackslash}textless130 mm Hg had optimal balance between efﬁcacy and safety. CONCLUSIONS: In patients with hypertension, a on-treatment systolic BP target of {\\textbackslash}textless130 mm Hg achieved optimal balance between efﬁcacy and safety. Ó 2017 Elsevier Inc. All rights reserved. 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