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HETEROGENEITY IN TARGET ORGAN DAMAGE WITH INTENSIVE BLOOD PRESSURE CONTROL: AN UPDATED SYSTEMATIC REVIEW
E542 JACC April 5, 2011 Volume 57, Issue 14
GENERAL CARDIOLOGY: HYPERTENSION, PREVENTION AND LIPIDS HETEROGENEITY IN TARGET ORGAN DAMAGE WITH INTENSIVE BLOOD PRESSURE CONTROL: AN UPDATED SYSTEMATIC REVIEW ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Sunday, April 03, 2011, 3:30 p.m.-4:45 p.m.
Session Title: Cardiovascular Complications in Hypertension: Current and Emerging Predictors Abstract Category: 16. Hypertension Session-Poster Board Number: 1047-306 Authors: VIVEK BHATIA, Shiv K. Agarwal, Girish N. Nadkarni, Manpreet S. Sabharwal, Alexandros Briasoulis, Narender Annapureddy, Sripal Bangalore, Franz H. Messerli, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY Background: Newly published studies advocate even lower BP targets than recommended by the current JNC 7 guidelines. We analyzed the effect of intensive (< 135/85) vs. standard (<140-160/90-100) lowering of BP on mortality and risk of stroke. Methods: A PUBMED and COCHRANE search for randomized clinical trials (1966-2010) comparing patients randomized to lower vs. standard BP targets and providing data on any of the primary outcomes below. Two reviewers (VB and SA) independently extracted data on demographics, baseline Systolic and Diastolic Blood (SBP, DBP), target SBP, target DBP and mortality. Primary outcomes assessed were all-cause mortality; Cardiovascular (CV) mortality; and Cerebrovascular accidents (CVA) risk. Results: A total of 9 RCTs with 38,535 participants were included in the analysis. As compared to standard group, intensive BP lowering group exhibited a higher relative risk (RR) of 1.05 for all-cause mortality. However, this risk was not statistically significant (95% Confidence Interval 0.841.31; p=0.65; Fig. 1A). Six studies reported CV mortality which showed an increased risk with intensive blood pressure (RR 1.21; 95% CI 1.04-1.42; p=0.018; Fig. 1B). Five studies reported rates of CVA which showed a decreased trend towards mortality risk with intensive control (RR 0.65; 95% CI 0.42-0.99; p=0.04; Fig. 1C) Conclusions: With Intensive control of BP to lower targets, there is a significant heterogeneity in target organ damage; while CV mortality increases there is a lower risk of CVA.
GENERAL CARDIOLOGY: HYPERTENSION, PREVENTION AND LIPIDS HETEROGENEITY IN TARGET ORGAN DAMAGE WITH INTENSIVE BLOOD PRESSURE CONTROL: AN UPDATED SYSTEMATIC REVIEW ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Sunday, April 03, 2011, 3:30 p.m.-4:45 p.m.
Session Title: Cardiovascular Complications in Hypertension: Current and Emerging Predictors Abstract Category: 16. Hypertension Session-Poster Board Number: 1047-306 Authors: VIVEK BHATIA, Shiv K. Agarwal, Girish N. Nadkarni, Manpreet S. Sabharwal, Alexandros Briasoulis, Narender Annapureddy, Sripal Bangalore, Franz H. Messerli, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY Background: Newly published studies advocate even lower BP targets than recommended by the current JNC 7 guidelines. We analyzed the effect of intensive (< 135/85) vs. standard (<140-160/90-100) lowering of BP on mortality and risk of stroke. Methods: A PUBMED and COCHRANE search for randomized clinical trials (1966-2010) comparing patients randomized to lower vs. standard BP targets and providing data on any of the primary outcomes below. Two reviewers (VB and SA) independently extracted data on demographics, baseline Systolic and Diastolic Blood (SBP, DBP), target SBP, target DBP and mortality. Primary outcomes assessed were all-cause mortality; Cardiovascular (CV) mortality; and Cerebrovascular accidents (CVA) risk. Results: A total of 9 RCTs with 38,535 participants were included in the analysis. As compared to standard group, intensive BP lowering group exhibited a higher relative risk (RR) of 1.05 for all-cause mortality. However, this risk was not statistically significant (95% Confidence Interval 0.841.31; p=0.65; Fig. 1A). Six studies reported CV mortality which showed an increased risk with intensive blood pressure (RR 1.21; 95% CI 1.04-1.42; p=0.018; Fig. 1B). Five studies reported rates of CVA which showed a decreased trend towards mortality risk with intensive control (RR 0.65; 95% CI 0.42-0.99; p=0.04; Fig. 1C) Conclusions: With Intensive control of BP to lower targets, there is a significant heterogeneity in target organ damage; while CV mortality increases there is a lower risk of CVA.