| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias «Additional comments for included studies...»2 |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Verdecchia P, Staessen JA, Angeli F, ym. Usual ver...»1 | Cardio-Sis (RCT) | Age >55 and at least 1 CVD risk factor, Italy | Target systolic BP <130 or <140 | 1) LVH Incidence; 2) CVD events | Low |
| «ACCORD Study Group, Cushman WC, Evans GW, ym. Effe...»2 | ACCORD (RCT) | Type 2 diabetes. Age >40 with CVD, >55 with risk factors, USA and Canada | Target systolic BP <120 or <140 | MI, Stroke, Death | Low |
| «SPS3 Study Group, Benavente OR, Coffey CS, ym. Blo...»3 | SPS3 (RCT) | Patients with lacunar infarcts in MRI, North America, Latin America, and Spain | Target systolic BP <130 vs 130-149 | Stroke | Low |
| «SPRINT Research Group, Wright JT Jr, Williamson JD...»4 | SPRINT (RCT) | No diabetes. Age >50 and risk factors or age >75, USA | Target systolic BP <120 or <140 | ACS, stroke, HF, death | Moderate |
| «Zhang W, Zhang S, Deng Y, ym. Trial of Intensive B...»5 | STEP (RCT) | 60-80 years with hypertension, China, | Target systolic BP 110-130 vs. 130-150 | Stroke, ACS, HF, PCI, AF, death |
Low |
| «He J, Ouyang N, Guo X, ym. Effectiveness of a non-...»6 | CRHCP (RCT) | >40 years with hypertension, China | Target BP 130/80 vs. "usual care" | MI, stroke, HF, death | High |
| «Liu J, Li Y, Ge J, ym. Lowering systolic blood pre...»7 | ESPRIT (RCT) | High CVD risk (CVD or 2 major risk factors), China | Target systolic BP <120 or <140 | MI, PCI, HF, stroke, death | Low |
| «Bi Y, Li M, Liu Y, ym. Intensive Blood-Pressure Co...»8 | BPROAD (RCT) | Diabetic individuals with increased CVD risk, China | Target systolic BP <120 or <140 | MI, stroke, HF, death | Low |
| Reference | Comments |
|---|---|
| «Verdecchia P, Staessen JA, Angeli F, ym. Usual ver...»1 | Eligible patient had to have at least one additional risk factor, as described in the guidelines of the European Society of Hypertension (cigarette smoking, total cholesterol ≥5·2 mmol/L, HDL cholesterol <1·0 mmol/L, LDL cholesterol ≥3·4 mmol/L, family history of premature cardiovascular disease in first degree relative [<65 years in women and <55 years in men], previous transient ischaemic attack or stroke, or established coronary or peripheral arterial disease). |
| «ACCORD Study Group, Cushman WC, Evans GW, ym. Effe...»2 | Type 2 diabetes mellitus and a glycated hemoglobin level of 7.5% or more and were 40 years of age or older with cardiovascular disease or 55 years of age or older with anatomical evidence of a substantial amount of atherosclerosis, albuminuria, left ventricular hypertrophy, or at least two additional risk factors for cardiovascular disease (dyslipidemia, hypertension, smoking, or obesity). |
| «SPS3 Study Group, Benavente OR, Coffey CS, ym. Blo...»3 | Eligible patients were aged 30 years or older, were normotensive or hypertensive, had had a recent (within 180 days), symptomatic, MRI-confirmed lacunar stroke, and were without surgically amenable ipsilateral carotid artery stenosis or high-risk cardioembolic sources. Main exclusion criteria included disabling stroke (modified Rankin score of 4 or higher), previous intracranial haemorrhage from non-traumatic causes, or cortical ischaemic stroke. |
| «SPRINT Research Group, Wright JT Jr, Williamson JD...»4 | Age >50 and an increased risk of cardiovascular events. Increased cardiovascular risk
was defined by one or more of the following: clinical or subclinical cardiovascular
disease other than stroke; chronic kidney disease, excluding polycystic kidney disease,
with an estimated glomerular filtration rate (eGFR) of 20 to less than 60 ml per minute
per 1.73 m2 of body-surface area, calculated with the use of the four-variable Modification
of Diet in Renal Disease equation; a 10-year risk of cardiovascular disease of 15%
or greater on the basis of the Framingham risk score; or an age of 75 years or older. Limitations: Unconventional BP measurement (unattended office blood pressure) method that may not be comparable to conventional office blood pressure measurement. |
| «Zhang W, Zhang S, Deng Y, ym. Trial of Intensive B...»5 | All eligible patients were required to be 60 to 80 years of age and to have hypertension with a systolic blood pressure of 140 to 190 mm Hg during three screening visits or to be taking antihypertensive medication. |
| «He J, Ouyang N, Guo X, ym. Effectiveness of a non-...»6 | All participating villages had a non-physician community health-care provider and
were at least 2 km away from one another. Individuals with known hypertension according
to non-physician community health-care providers' records and other village residents
aged at least 40 years were invited to blood pressure screenings in participating
villages to identify eligible participants. Individuals with mean untreated systolic
blood pressure of at least 140 mm Hg or diastolic blood pressure of at least 90 mm
Hg (≥130 or ≥80 mm Hg among those with clinical cardiovascular disease, diabetes,
or chronic kidney disease) or mean treated systolic blood pressure of at least 130
mm Hg or diastolic blood pressure of at least 80 mm Hg from six measures on two different
days were eligible for the study. Additional eligibility criteria included being enrolled
in the China New Rural Cooperative Medical Scheme (a health insurance plan covering
approximately 99% of rural residents in China for basic health-care services), not
pregnant or planning to become pregnant, and able to sign informed consent. Limitations: Cluster randomization of villages. Systolic BP at end of follow-up in conventional arm was 147·6 mmHg. |
| «Liu J, Li Y, Ge J, ym. Lowering systolic blood pre...»7 | High cardiovascular risk (ie, established cardiovascular disease or at least two major cardiovascular risk factors). Major cardiovascular risk factors were aged 60 years or older for men or 65 years or older for women, diabetes, dyslipidemia, and current smoker. |
| «Bi Y, Li M, Liu Y, ym. Intensive Blood-Pressure Co...»8 | Increased risk of cardiovascular disease was defined as the meeting of one or more of the following criteria: a history of clinical cardiovascular disease at least 3 months before enrollment in the trial, subclinical cardiovascular disease within 3 years before enrollment, two or more cardiovascular disease risk factors, and chronic kidney disease (CKD) with an estimated glomerular filtration rate (eGFR) of 30 to less than 60 ml per minute per 1.73 m2 of body-surface area. |
Results
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Absolute number of events (%) I | Absolute number of events (%) C | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I=intervention; C=comparison; CI=confidence interval | |||||
| «Verdecchia P, Staessen JA, Angeli F, ym. Usual ver...»1 | 1 study (558 I/553 C) | 2.0 y | 27 (4.8) | 52 (9.4) | 0.50 (0.31–0.79); p=0·003 |
| «ACCORD Study Group, Cushman WC, Evans GW, ym. Effe...»2 | 1 study (2362 I/2371 C) | 5.0 y | 208 (8.8) | 237 (10.0) | 0.88 (0.73- 1.06); p=0.20 (significant for stroke) |
| «SPS3 Study Group, Benavente OR, Coffey CS, ym. Blo...»3 | 1 study (1501 I/1519 C) | 3.7 y | 125 (2.3) | 152 (2.8) | 0.81 (0·64-1·03), p=0·08 |
| «SPRINT Research Group, Wright JT Jr, Williamson JD...»4 | 1 study (4678 I/4683 C) | 3.3 y | 243 (5.2) | 319 (6.8) | 0.75 (0.64-0.89), p<0.001 |
| «Zhang W, Zhang S, Deng Y, ym. Trial of Intensive B...»5 | 1 study (4243 I/4268 C) | 3.3 y | 147 (3.5) | 196 (4.6) | 0.74 (0.60-0.92); p=0.007 |
| «He J, Ouyang N, Guo X, ym. Effectiveness of a non-...»6 | 1 study (17407 I/16588 C) | 36.8 mnths | 808 (4.6) | 1127 (6.8) | 0.67 (0.61–0.73); p<0.0001 |
| «Liu J, Li Y, Ge J, ym. Lowering systolic blood pre...»7 | 1 study (5624 I/5631 C) | 3.4 y | 547 (9.7) | 623 (11.1) | 0.88 (0.78–0.99); p=0·028 |
| «Bi Y, Li M, Liu Y, ym. Intensive Blood-Pressure Co...»8 | 1 study (6414 I/6407 C) | 4.2 y | 393 (6.1) | 492 (7.7) | 0.79 (0.69-0.90; P<0.001 |
| Level of evidence: high | |||||