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Intensive Control of Blood Pressure Reduces Mortality but Increases Adverse Events

2015-11-10

An important study was published in the New England Journal of Medicine recently: http://www.nejm.org/doi/full/10.1056/NEJMoa1511939  This study concluded that reducing the blood pressure to a goal of 120 systolic reduced mortality by a third over using the goal of 140 systolic.

Here is the conclusion of the study, which enrolled nearly ten thousand patients 50 and older with at least one cardiovascular risk factor (but not diabetes) for a year of treatment if their blood pressure was 130 or greater:

Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group.

Surprisingly, hypotensive episodes were increased, but falls with injury were not significantly increased.

The relative risk (RR) of mortality for intensive treatment was 0.75, meaning a treated patient had 75% of the risk of dying of an undertreated patient.  This means that the already impressive gains in mortality realized by treatment of high blood pressure will be further improved by more intensive treatment.  This study answers the question of “how much treatment is enough?” which has troubled doctors for years.

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