BACKGROUND:Previous meta-analyses resurrected the debated statement “the lower, the better” following blood pressure (BP)-lowering treatment. We investigated the benefits of BP-lowering treatment at different BP targets by prevention category.METHODS:The meta-analysis protocol was registered at the International Prospective Register of Systematic Reviews (CRD42022379249). The database included 115 BP-lowering or comparison trials from patients with (n=241 089) or without (n=198 937) previous cardiovascular events. Prevention disease groups were stratified by in-treatment achieved BP, drug class versus placebo, and drug class versus other classes. Risk ratios and 95% CIs of major adverse cardiovascular events were calculated.RESULTS:Following a standard (10/5 mm Hg) BP reduction, major adverse cardiovascular event relative risk reductions were not different between prevention groups (primary, 25% [95% CI, 18%–31%]; secondary, 28% [95% CI, 20%–37%]). For achieved systolic BP of at least 140 mm Hg, between 130 and 140 mm Hg, and <130 mm Hg (nadir, 125 mm Hg), (1) risk ratios of major adverse cardiovascular events and absolute risk reductions were not different between prevention groups across systolic BP strata, and (2) residual risk, though 4.1× greater in secondary than primary prevention, decreased in primary prevention from higher to lower systolic BP targets. The effect of separate drugs versus others on the primary outcome was not different between prevention groups.CONCLUSIONS:BP-lowering treatment benefits did not differ by prevention group to a nadir of 125 mm Hg for systolic BP. Although residual risk in secondary prevention is higher than in primary prevention, it gradually decreases at progressively lower systolic BP targets in primary prevention.REGISTRATION:URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42022379249.

中文翻译：

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重新审视一级和二级预防中降低血压对心血管的益处：关注目标和残留风险——系统回顾和荟萃分析


背景：之前的荟萃分析重新提出了降血压治疗后“血压越低越好”这一有争议的说法。我们按预防类别研究了不同血压目标的降压治疗的益处。方法：荟萃分析方案在国际前瞻性系统评价登记册上注册（CRD42022379249）。该数据库包括 115 项降压或比较试验，这些试验来自既往有心血管事件（n=241 089）或无心血管事件（n=198 937）的患者。预防疾病组根据治疗中达到的血压、药物类别与安慰剂、药物类别与其他类别进行分层。计算了主要不良心血管事件的风险比和 95% CI。 结果：在标准 (10/5 mm Hg) 血压降低后，主要不良心血管事件相对风险降低在预防组之间没有差异（主要为 25% [95%]） CI，18%–31%]；次要，28% [95% CI，20%–37%]）。对于达到至少 140 mm Hg、130 至 140 mm Hg 以及 <130 mm Hg（最低点，125 mm Hg）的收缩压，(1) 主要不良心血管事件的风险比和绝对风险降低在预防之间没有差异(2) 残余风险虽然二级预防比一级预防高 4.1 倍，但一级预防从较高收缩压目标到较低收缩压目标有所降低。不同药物与其他药物对主要结局的影响在预防组之间没有差异。结论：预防组的降压治疗效果没有差异，收缩压最低为 125 mm Hg。尽管二级预防中的残余风险高于一级预防，但随着一级预防中收缩压目标的逐渐降低，残余风险逐渐降低。注册：网址：https://www.crd.york.ac.uk/PROSPERO/；唯一标识符：CRD42022379249。