Benefit-harm trade-offs of intensive versus standard blood pressure control: pooled individual-participant analysis
Pooling more than 80,000 patients from six major trials, aiming for a lower blood-pressure target cut heart attacks, strokes, heart failure and cardiovascular death, and the overall balance stayed favorable even after accounting for the extra kidney-related and other side effects.
Background
Intensive blood pressure control is recommended by major guidelines, but its overall benefit-harm balance, and how net clinical benefit varies by target and patient characteristics, remains uncertain - particularly regarding renal harms.
Study design
Investigators conducted a post-hoc, pooled participant-level analysis of six randomized trials (ACCORD BP, SPRINT, ESPRIT, BPROAD, STEP, and CRHCP), comparing intensive systolic targets (<120 or <130 mm Hg) with standard treatment in 80,220 participants (median age 64 years; median follow-up 3.2 years), analyzed with Bayesian hierarchical models.
Key findings
The composite cardiovascular outcome occurred in 5.3% (intensive) versus 7.1% (standard) (HR 0.76, 95% CrI 0.72-0.81). Intensive control gave a 1.73% absolute cardiovascular risk reduction (NNT 58) and a 1.82% absolute increase in adverse events of interest (NNH 55). The overall net benefit was 1.14 and remained positive (1.13) when kidney-related adverse events were considered.
Safety
Harms of interest included hypotension, syncope, and renal-related events; despite these, the weighted benefit-harm balance favored intensive control.
Category
Research
Source
Lancet
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