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Effect of intensive lowering of systolic blood pressure treatment on heart failure events: a meta-analysis of randomized controlled studies

Journal of Human Hypertension volume 33, pages 648–657 (2019)Cite this article

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Abstract

We performed this meta-analysis to assess the association between intensive systolic blood pressure (SBP)-lowering strategies and heart failure (HF). A comprehensive literature review was conducted using English and Chinese databases from their origination through April 2018. Random-effects models were used to calculate pooled relative risks and 95% confidence intervals. Nine randomized controlled trials including a total of 39,936 hypertensive patients were ultimately included in our meta-analysis. Pooled analysis of these nine trials showed that a treatment target of SBP ≤140 mmHg was associated with a significant reduction in HF risk (RR: 0.73, 95%CI: 0.62–0.87). Furthermore, the pooled analysis of prospective randomized controlled trials indicated a significant association between intensive lowering of SBP and HF risk (RR: 0.75, 95%CI: 0.62–0.90) and showed that intensive lowering of SBP could decrease risk of HF in patients without diabetes mellitus (RR: 0.69, 95%CI: 0.52–0.91) and in those ≥65 years old (RR: 0.72, 95%CI: 0.56–0.93), but this finding was not shown for patients with diabetes mellitus (RR: 0.81, 95%CI: 0.56–1.19) or in those <65 years old (RR: 0.81, 95%CI: 0.56–1.19). When intensive lowering of SBP achieved an SBP ≤ 120 mmHg, a pooled analysis indicated a positive association between SBP and HF risk (RR: 0.75, 95%CI: 0.63–0.89), and a pooled analyses showed that intensive lowering of SBP could decrease risk of HF in patients without diabetes mellitus (RR: 0.71, 95%CI: 0.51–0.98) and in those ≥65 years old (RR: 0.76, 95%CI: 0.58–0.98); however, this result was not found for patients with diabetes mellitus (RR: 0.81, 95%CI: 0.56–1.19) or those <65 years old (RR: 0.81, 95%CI: 0.56–1.19). The existing data support the results of a positive association between intensive SBP-lowering treatment and HF risk, especially for those patients without diabetes and those older than 65 years. However, additional prospective studies are still needed to confirm these associations.

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Acknowledgements

Anhui Medical University provided access to the databases of published articles.

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Author notes

  1. These authors contributed equally: Yun Zhang and Mingming Liang

Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China

    Yun Zhang, Mingming Liang, Guangbo Qu, Tingting Shi, Min Min & Yehuan Sun

  2. The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi road, Hefei, 230022, Anhui, China

    Chenyu Sun

  3. Department of Hospital Infection Prevention and Control, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong road, Hefei, 230601, Anhui, China

    Yile Wu

  4. Center for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China

    Yehuan Sun

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Correspondence to Yehuan Sun.

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Zhang, Y., Liang, M., Sun, C. et al. Effect of intensive lowering of systolic blood pressure treatment on heart failure events: a meta-analysis of randomized controlled studies. J Hum Hypertens 33, 648–657 (2019). https://doi.org/10.1038/s41371-019-0221-z

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