BACKGROUND Systolic blood pressure (SBP) lowering reduces major cardiovascular disease (CVD) and all-cause mortality. However, the optimal target for SBP lowering remains controversial. METHODS We included trials with random allocation to an SBP <130 mm Hg treatment target and CVD as the primary outcome. Data were extracted from each study independently and in duplicate using a standardized protocol. Random-effects meta-analysis was used to obtain pooled hazard ratios (HRs) and 95% CIs for CVD and all-cause mortality comparing SBP <130 and ≥130 mm Hg treatment targets. A secondary analysis compared the same outcomes for randomization to an SBP target of <120 or <140 mm Hg. RESULTS Seven trials, including 72 138 participants, met the eligibility criteria. Compared with an SBP target of ≥130 mm Hg, an SBP target of <130 mm Hg significantly reduced major CVD (HR, 0.78 [95% CI, 0.70-0.87]) and all-cause mortality (HR, 0.89 [95% CI, 0.79-0.99]). Compared with an SBP target of <140 mm Hg, an intensive SBP target of <120 mm Hg significantly reduced major CVD (HR, 0.82 [95% CI, 0.74-0.91]), but all-cause mortality was marginally insignificant (HR, 0.85 [95% CI, 0.71-1.01]). Adverse events were significantly more likely in the intensive SBP target groups, but the absolute risks were low. CONCLUSIONS This study suggests targeting an SBP <130 mm Hg significantly reduces the risks of major CVD and all-cause mortality. The findings also support an SBP target of <120 mm Hg, based on a smaller number of trials. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023490693.

中文翻译：

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最佳抗高血压收缩压：系统评价和荟萃分析。


背景 收缩压 （SBP） 降低可降低主要心血管疾病 （CVD） 和全因死亡率。然而，降低 SBP 的最佳目标仍然存在争议。方法 我们纳入了随机分配到 SBP <、130 mm Hg 治疗目标和 CVD 作为主要结局的试验。使用标准化方案从每项研究中独立和一式两份地提取数据。采用随机效应荟萃分析获得 CVD 和 95% CI 的合并风险比 （HRs） 和 95% CIs，比较 SBP <130 和 ≥130 mm Hg 治疗目标。一项二次分析将随机分组的相同结局与 <120 或 <140 mm Hg 的 SBP 目标进行了比较。结果 七项试验，包括 72 138 名参与者，符合合格标准。与 ≥130 mm Hg 的 SBP 目标相比，<130 mm Hg 的 SBP 目标显著降低了主要 CVD （HR， 0.78 [95% CI， 0.70-0.87]）和全因死亡率 （HR， 0.89 [95% CI， 0.79-0.99]）。与 <140 mm Hg 的 SBP 目标相比，<120 mm Hg 的强化 SBP 目标显著降低了主要 CVD （HR，0.82 [95% CI，0.74-0.91]），但全因死亡率略低 （HR，0.85 [95% CI，0.71-1.01]）。强化 SBP 目标组不良事件的可能性显著更高，但绝对风险较低。结论 本研究建议以 <130 mm Hg 为 SBP 可显著降低主要 CVD 和全因死亡的风险。基于少量试验，研究结果还支持 <120 mm Hg 的 SBP 目标。注册 URL：https://www.crd.york.ac.uk/PROSPERO/;唯一标识符：CRD42023490693。