Abstract 11151: Blood Pressure Targets in Patients with Coronary Artery Disease: Observations from Traditional and Bayesian Random Effects Meta-Analysis of Randomized Trials
Context: Most guidelines for treatment of hypertension including the JNC-7 recommend a blood pressure (BP) goal of <140/90 mm Hg for hypertensive patients and a more aggressive goal of <130/80 mm Hg for patients with coronary artery disease (CAD)/cardiovascular disease. However, this is largely based on expert consensus. The optimal BP target in subjects with CAD is therefore not well defined.
Objective: To define the optimal systolic pressure target in patients with CAD.
Data Sources and Study Selection: PUBMED, EMBASE, and CENTRAL searches for randomized clinical trials (RCTs), until May 2011, of antihypertensive therapy in patients with CAD, enrolling at least 100 patients, with achieved systolic pressure of ≤135 mm Hg in the “intensive BP control” group and ≤140 mm Hg in the “standard BP control” group with follow-up for at least 1 year and evaluating cardiovascular events.
Data Synthesis: We identified 15 RCTs enrolling 66 504 participants with 276 328 patient-years of follow-up. Intensive BP control group (≤135 mm Hg) was associated with a 15% decrease in heart failure rate and 10% decrease in stroke rate, driven largely by trials with a more intensive BP control (≤130 mm Hg), However, intensive BP control conferred no benefit for outcomes such as cardiovascular death, myocardial infarction, angina pectoris or revascularization and was associated with a 105% increase in the risk of hypotension. Meta regression analysis showed that for each 10mm Hg lower systolic pressure, there was a 7.6 and 5.6 per 1000 patient-years decrease in CV death and stroke; a 7.4 per 1000 patient-years increase in myocardial infarction and a 33.4 per 1000 patient-years increase in hypotension. The results were similar in a Bayesian random-effects model.
Conclusions: The present body of evidence suggests that in patients with CAD, there is target organ heterogeneity in that the risk for heart failure and stroke decreases with intensive BP control (≤135 mm Hg) but at the expense of increased risk of hypotension and possibly other cardiovascular outcomes.
- © 2011 by American Heart Association, Inc.