Intensive blood pressure lowering cuts major adverse cardiovascular events, mortality

Intensive blood pressure treatment targeting systolic blood pressure <120 mm Hg results in lower rates of major adverse cardiovascular events and lower all-cause mortality than a standard treatment target among patients at increased cardiovascular risk, according to a study published in the May 20 issue of the New England Journal of Medicine.

Cora E. Lewis, M.D., M.S.P.H., from the University of Alabama at Birmingham, and colleagues randomly assigned 9,361 participants at increased risk for cardiovascular disease without diabetes or previous stroke to adhere to an intensive treatment target (systolic blood pressure <120 mm Hg) or standard treatment target (<140 mm Hg).

The researchers found that the rates of the primary outcome (composite of myocardial infarction, other acute coronary syndromes, stroke, acute decompensated heart failure, or death from cardiovascular causes) and all-cause mortality were significantly lower during the trial in the intensive-treatment group versus the standard-treatment group at a median of 3.33 years of follow-up (hazard ratios, 0.73 and 0.75, respectively). In the intensive-treatment group, serious adverse events of hypotension, electrolyte abnormalities, acute kidney injury or failure, and syncope occurred significantly more frequently. Similar patterns were seen for treatment benefit and adverse events when trial and posttrial follow-up data were combined.

“During a posttrial observational period, the achieved blood-pressure differential between the treatment groups was attenuated, and more frequent heart failure was noted in the intensive-treatment group,” the authors write.

Azilsartan and azilsartan combined with chlorthalidone were donated by Takeda Pharmaceuticals International and Arbor Pharmaceuticals; neither had a role in the trial.