Benefits of Hypertension Treatment Depends Somewhat on Starting Blood Pressure Level Interview with:

Blood pressure monitor reading 120/80 copyright American Heart Association

Blood pressure monitor reading 120/80
copyright American Heart Association

Dr. Mattias Brunström
Department of Public Health and Clinical Medicine
Umeå University,Sweden What is the background for this study? What are the main findings?

Response: Current guidelines recommend a systolic blood pressure treatment target below 140 mm Hg for most people. Since the publication of SPRINT however, many have suggested guidelines should be changed, recommending further blood pressure lowering.

We performed a systematic review and meta-analysis of randomized clinical trials comparing different blood pressure targets or antihypertensive treatment verus placebo. We separated primary preventive trials from secondary preventive trials, and stratified primary preventive trials by mean baseline systolic blood pressure. The analyses included 74 trials, with in total > 300 000 participants. Interestingly, we found that treatment effect was dependent on baseline systolic blood pressure in people without previous CVD.

While primary preventive treatment reduced the risk of death and cardiovascular disease if systolic blood pressure was 140 mm Hg or higher, treatment effect was neutral if systolic blood pressure was below 140 mm Hg. What should clinicians and patients take away from your report?

Response: I think the most important message is that the effect of blood pressure lowering depends on the patient’s blood pressure level.

In patients with high blood pressure, we can effectively reduce mortality and cardiovascular morbidity with cheap and well tolerated drugs. At normotensive levels, you cannot expect treatment to reduce the risk of cardiovascular events further. Focus should thus be on getting all patients below 140 mm Hg. Thank you for your contribution to the community.


Brunström M, Carlberg B. Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure LevelsA Systematic Review and Meta-analysisJAMA Intern Med. Published online November 13, 2017. doi:10.1001/jamainternmed.2017.6015

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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