| Intensive blood pressure lowering strategies | hypertension, in all type of patients | vs less intensive blood pressure lowering strategie | cardiovascular events by 17% suggested Cardiovascular death by 16% suggested myocardial infarction (fatal and non fatal) by 14% suggested stroke (fatal and non fatal) by 17% suggested Serious adverse event by 104% suggested Heart failure by 27% suggested left ventricular hypertrophy by 33% suggested End stage renal disease by 15% suggested All cause death by 11% suggested | | Endpoint | TE [95% CI] | p val | I2 | n | k | |
|---|
| cardiovascular events | 0.83 [0.77 0.89] | p=0.04 | 0 | 35931 | 13 | HOT, ABCD target (H) , AASK, ABCD target (N) , ACCORD blood pressure, Cardio-Sis, SPRINT, UKPDS-HDS, JATOS, VANLISH, SPS3, Wei, PAST-BP, | | Cardiovascular death | 0.84 [0.74 0.96] | p=0.04 | 0 | 35158 | 13 | HOT, ABCD target (H) , AASK, REIN-2, ABCD target (N) , ACCORD blood pressure, SPRINT, UKPDS-HDS, JATOS, VANLISH, HOMED-BP, SPS3, Wei, | | myocardial infarction (fatal and non fatal) | 0.86 [0.75 0.99] | p=0.04 | 0 | 16065 | 10 | ABCD target (H) , ABCD target (N) , ACCORD blood pressure, Cardio-Sis, SPRINT, UKPDS-HDS, JATOS, VANLISH, HOMED-BP, Wei, | | stroke (fatal and non fatal) | 0.83 [0.73 0.96] | p=0.04 | 0 | 34855 | 11 | HOT, ABCD target (H) , ABCD target (N) , ACCORD blood pressure, Cardio-Sis, SPRINT, UKPDS-HDS, JATOS, VANLISH, HOMED-BP, Wei, | | Serious adverse event | 2.04 [1.46 2.85] | p=0.04 | 0 | 5071 | 2 | REIN-2, ACCORD blood pressure, | | Heart failure | 0.73 [0.61 0.87] | p=0.04 | 0 | 34891 | 9 | HOT, ABCD target (H) , ABCD target (N) , ACCORD blood pressure, Cardio-Sis, SPRINT, UKPDS-HDS, JATOS, Wei, | | left ventricular hypertrophy | 0.67 [0.46 0.97] | p=0.04 | 0 | 967 | 1 | Cardio-Sis, | | End stage renal disease | 0.85 [0.75 0.97] | p=0.04 | 0 | 16443 | 6 | MDRD, AASK, REIN-2, Toto, ACCORD blood pressure, SPRINT, | | All cause death | 0.89 [0.81 0.97] | p=0.04 | 0 | 36328 | 16 | HOT, ABCD target (H) , AASK, REIN-2, ABCD target (N) , Toto, ACCORD blood pressure, Cardio-Sis, SPRINT, UKPDS-HDS, JATOS, VANLISH, HOMED-BP, SPS3, Wei, PAST-BP, | | non cardiovascular death | 0.97 [0.78 1.19] | p=1.00 | 0 | 21172 | 5 | HOT, ABCD target (H) , AASK, REIN-2, ABCD target (N) , |
| Trial | Studied treatment | Control | Patients |
|---|
| MDRD, 1994 | low target blood pressure (mean arterial pressure < 92 mm Hg) | usual target blood pressure (mean arterial pressure < 107 mm Hg) | patients with predominantly nondiabetic kidney disease and a glomerular filtration rate of 13 to 55 mL/min per 1.73 m2 | | HOT, 1994 | less or equal than 85 mmHg, or less or equal than 80 mmHg | less or equal than 90 mmHg | patients with diastolic blood pressure between 100 mmHg and 115 mmHg | | ABCD target (H) , 2000 | intensive treatment with a diastolic blood pressure
goal of 75 mmHg | moderate treatment with a diastolic blood pressure goal of 80-89 mmHg | diabetes patients with DBP >=90 mmHg | | AASK, 2002 | arterial pressure goal of 92 mm Hg or lower | usual mean arterial pressure goal of 102 to 107 mm Hg/pj | African-Americans,with diastolic blood pressure higher than 94mmHg and a glomerular filtration rate between 20 and 65 ml/min per 1.73 m2 | | REIN-2, 2005 | intensified (systolic/diastolic <130/80 mm Hg) blood-pressure control | conventional (diastolic <90 mm Hg) blood-pressure control | patients with non-diabetic proteinuric nephropathies receiving background treatment with the ACE inhibitor ramipril | | ABCD target (N) , 2002 | intensive treatment (diastolic blood pressure decrease
of 10 mmHg below baseline DBP) | moderate treatment (diastolic blood pressure goal of 80-89 mmHg) | diabetes patients with diastolic
blood pressure between 80 and 89mmHg | | Toto, 1995 | strict blood pressure control (DBP 65 to 80 mm Hg) | usual blood pressure control (DBP 85 to 95 mm Hg) | non-diabetic patients (age 25 to 73) with long-standing hypertension (DBP > or = 95 mm Hg), chronic renal insufficiency (GFR < or = 70 m/min/1.73 m2) and a normal urine sediment | | ACCORD blood pressure, 2008 | intensive therapy, targeting a systolic pressure of less than 120 mm Hg | standard therapy, targeting a systolic pressure of less than 140 mm Hg | patients with a median glycated hemoglobin level of 8.1% at high risk for cardiovascular events | | Cardio-Sis, 2009 | tighter control of systolic BP with a goal of <130 mm Hg | usual control, with a goal of <140 mm Hg | nondiabetic patients with hypertension and with SBP of 150 mm Hg or higher confirmed at two different times | | SPRINT, 2015 | target of 120 mm Hg | target of 140 mm Hg | high-risk hypertensive adults 50 years of age and older with one additional cardiovascular risk factor or preexisting kidney disease | | UKPDS-HDS, 1998 | blood pressure of <150/85 mm Hg (with the use of an angiotensin converting enzyme inhibitor captopril or a beta blocker atenolol as main treatment) | less tight control aiming at a blood pressure of <180/105 mm Hg | patients with type 2 diabetes | | JATOS, 2008 | strict treatment to maintain systolic blood pressure below 140 mmHg | mild treatment to maintain systolic blood pressure below 160 but at or above 140 mmHg | elderly hypertensive patients with essential hypertension (65-85 years old, with a pretreatment systolic blood pressure of above 160 mmHg) | | VANLISH, 2010 | strict blood pressure control (<140 mm Hg) | moderate blood pressure control (> or =140 mm Hg to <150 mm Hg) | patients aged 70 to 84 years with isolated systolic hypertension (sitting blood pressure 160 to 199 mm Hg) | | HOMED-BP, 2012 | tight control (<125/<80 mm Hg (TC)) of HBP | usual control (125-134/80-84 mm Hg (UC)) | with an untreated systolic/diastolic HBP of 135-179/85-119 mm Hg | | SPS3, 2013 | less than 130 mm Hg | 130-149 mm Hg | patients lived in North America, Latin America, and Spain and had recent, MRI-defined symptomatic lacunar infarctions | | Wei, 2013 | BP <=140/90 mm Hg | BP <=150/90 mm Hg | Chinese hypertensive patients older than 70 years | | PAST-BP, 2015 | | | |
| |
| Intensive blood pressure lowering strategies | hypertension, in non diabetic patients | vs less intensive blood pressure lowering strategie | cardiovascular events by 17% suggested Heart failure by 36% suggested left ventricular hypertrophy by 33% suggested End stage renal disease by 19% suggested | | Endpoint | TE [95% CI] | p val | I2 | n | k | |
|---|
| cardiovascular events | 0.83 [0.75 0.93] | p=0.04 | 0 | 29262 | 3 | HOT, Cardio-Sis, SPRINT, | | Cardiovascular death | 0.89 [0.72 1.10] | p=1.00 | 0 | 28489 | 3 | HOT, REIN-2, SPRINT, | | myocardial infarction (fatal and non fatal) | 0.82 [0.64 1.06] | p=1.00 | 0 | 10472 | 2 | Cardio-Sis, SPRINT, | | stroke (fatal and non fatal) | 0.98 [0.80 1.19] | p=1.00 | 0 | 29262 | 3 | HOT, Cardio-Sis, SPRINT, | | Serious adverse event | 1.39 [0.81 2.39] | p=1.00 | 0 | 338 | 1 | REIN-2, | | Heart failure | 0.64 [0.49 0.84] | p=0.04 | 0 | 29262 | 3 | HOT, Cardio-Sis, SPRINT, | | left ventricular hypertrophy | 0.67 [0.46 0.97] | p=0.04 | 0 | 967 | 1 | Cardio-Sis, | | End stage renal disease | 0.81 [0.69 0.95] | p=0.04 | 0 | 10616 | 4 | MDRD, REIN-2, Toto, SPRINT, | | All cause death | 0.90 [0.79 1.03] | p=1.00 | 0 | 29677 | 5 | HOT, REIN-2, Toto, Cardio-Sis, SPRINT, | | non cardiovascular death | 1.06 [0.84 1.35] | p=1.00 | 0 | 19128 | 2 | HOT, REIN-2, |
| Trial | Studied treatment | Control | Patients |
|---|
| MDRD, 1994 | low target blood pressure (mean arterial pressure < 92 mm Hg) | usual target blood pressure (mean arterial pressure < 107 mm Hg) | patients with predominantly nondiabetic kidney disease and a glomerular filtration rate of 13 to 55 mL/min per 1.73 m2 | | HOT, 1994 | less or equal than 85 mmHg, or less or equal than 80 mmHg | less or equal than 90 mmHg | patients with diastolic blood pressure between 100 mmHg and 115 mmHg | | REIN-2, 2005 | intensified (systolic/diastolic <130/80 mm Hg) blood-pressure control | conventional (diastolic <90 mm Hg) blood-pressure control | patients with non-diabetic proteinuric nephropathies receiving background treatment with the ACE inhibitor ramipril | | Toto, 1995 | strict blood pressure control (DBP 65 to 80 mm Hg) | usual blood pressure control (DBP 85 to 95 mm Hg) | non-diabetic patients (age 25 to 73) with long-standing hypertension (DBP > or = 95 mm Hg), chronic renal insufficiency (GFR < or = 70 m/min/1.73 m2) and a normal urine sediment | | Cardio-Sis, 2009 | tighter control of systolic BP with a goal of <130 mm Hg | usual control, with a goal of <140 mm Hg | nondiabetic patients with hypertension and with SBP of 150 mm Hg or higher confirmed at two different times | | SPRINT, 2015 | target of 120 mm Hg | target of 140 mm Hg | high-risk hypertensive adults 50 years of age and older with one additional cardiovascular risk factor or preexisting kidney disease |
| |
| Intensive blood pressure lowering strategies | hypertension, in patients with chronic kidney disease | vs less intensive blood pressure lowering strategie | End stage renal disease by 17% suggested | | Endpoint | TE [95% CI] | p val | I2 | n | k | |
|---|
| cardiovascular events | 0.87 [0.59 1.29] | p=1.00 | 0 | 1094 | 1 | AASK, | | Cardiovascular death | 0.91 [0.46 1.81] | p=1.00 | 0 | 1432 | 2 | AASK, REIN-2, | | myocardial infarction (fatal and non fatal) | no data | | stroke (fatal and non fatal) | no data | | Serious adverse event | 1.39 [0.81 2.39] | p=1.00 | 0 | 338 | 1 | REIN-2, | | Heart failure | no data | | left ventricular hypertrophy | no data | | End stage renal disease | 0.83 [0.72 0.96] | p=0.04 | 0 | 2349 | 4 | MDRD, AASK, REIN-2, Toto, | | All cause death | 0.89 [0.57 1.37] | p=1.00 | 0 | 1509 | 3 | AASK, REIN-2, Toto, | | non cardiovascular death | 0.88 [0.50 1.53] | p=1.00 | 0 | 1432 | 2 | AASK, REIN-2, |
| Trial | Studied treatment | Control | Patients |
|---|
| MDRD, 1994 | low target blood pressure (mean arterial pressure < 92 mm Hg) | usual target blood pressure (mean arterial pressure < 107 mm Hg) | patients with predominantly nondiabetic kidney disease and a glomerular filtration rate of 13 to 55 mL/min per 1.73 m2 | | AASK, 2002 | arterial pressure goal of 92 mm Hg or lower | usual mean arterial pressure goal of 102 to 107 mm Hg/pj | African-Americans,with diastolic blood pressure higher than 94mmHg and a glomerular filtration rate between 20 and 65 ml/min per 1.73 m2 | | REIN-2, 2005 | intensified (systolic/diastolic <130/80 mm Hg) blood-pressure control | conventional (diastolic <90 mm Hg) blood-pressure control | patients with non-diabetic proteinuric nephropathies receiving background treatment with the ACE inhibitor ramipril | | Toto, 1995 | strict blood pressure control (DBP 65 to 80 mm Hg) | usual blood pressure control (DBP 85 to 95 mm Hg) | non-diabetic patients (age 25 to 73) with long-standing hypertension (DBP > or = 95 mm Hg), chronic renal insufficiency (GFR < or = 70 m/min/1.73 m2) and a normal urine sediment |
| |
| Intensive blood pressure lowering strategies | hypertension, in diabetic patients | vs less intensive blood pressure lowering strategie | stroke (fatal and non fatal) by 41% suggested Serious adverse event by 158% suggested non cardiovascular death by 59% suggested | | Endpoint | TE [95% CI] | p val | I2 | n | k | |
|---|
| cardiovascular events | 0.89 [0.75 1.06] | p=1.00 | 0 | 5683 | 3 | ABCD target (H) , ABCD target (N) , ACCORD blood pressure, | | Cardiovascular death | 1.02 [0.74 1.40] | p=1.00 | 0 | 5683 | 3 | ABCD target (H) , ABCD target (N) , ACCORD blood pressure, | | myocardial infarction (fatal and non fatal) | 0.92 [0.74 1.15] | p=1.00 | 0 | 5683 | 3 | ABCD target (H) , ABCD target (N) , ACCORD blood pressure, | | stroke (fatal and non fatal) | 0.59 [0.41 0.85] | p=0.04 | 0 | 5683 | 3 | ABCD target (H) , ABCD target (N) , ACCORD blood pressure, | | Serious adverse event | 2.58 [1.68 3.94] | p=0.04 | 0 | 4733 | 1 | ACCORD blood pressure, | | Heart failure | 0.95 [0.72 1.25] | p=1.00 | 0 | 5683 | 3 | ABCD target (H) , ABCD target (N) , ACCORD blood pressure, | | left ventricular hypertrophy | no data | | End stage renal disease | 1.02 [0.71 1.47] | p=1.00 | 0 | 4733 | 1 | ACCORD blood pressure, | | All cause death | 0.97 [0.78 1.20] | p=1.00 | 0 | 5683 | 3 | ABCD target (H) , ABCD target (N) , ACCORD blood pressure, | | non cardiovascular death | 0.41 [0.19 0.91] | p=0.04 | 0 | 950 | 2 | ABCD target (H) , ABCD target (N) , |
| Trial | Studied treatment | Control | Patients |
|---|
| ABCD target (H) , 2000 | intensive treatment with a diastolic blood pressure
goal of 75 mmHg | moderate treatment with a diastolic blood pressure goal of 80-89 mmHg | diabetes patients with DBP >=90 mmHg | | ABCD target (N) , 2002 | intensive treatment (diastolic blood pressure decrease
of 10 mmHg below baseline DBP) | moderate treatment (diastolic blood pressure goal of 80-89 mmHg) | diabetes patients with diastolic
blood pressure between 80 and 89mmHg | | ACCORD blood pressure, 2008 | intensive therapy, targeting a systolic pressure of less than 120 mm Hg | standard therapy, targeting a systolic pressure of less than 140 mm Hg | patients with a median glycated hemoglobin level of 8.1% at high risk for cardiovascular events |
| |
