Blood pressure targets: comparing lower versus standard targets for people with hypertension

IntroductionHypertension is a leading cause of mortality worldwide and its prevalence is expected to rise over the next decade. Sex differences exist in the epidemiology and pathophysiology of hypertension. It is well established that antihypertensive treatment can significantly reduce the risk for stroke and other cardiovascular disease events. However, it remains unclear whether this effect is dependent on sex. In this protocol, we outlined a systematic review and meta-analysis to evaluate the effects of antihypertensive therapy in (1) reducing blood pressure and (2) preventing cardiovascular morbidity and mortality outcomes for each sex separately.Methods and analysisThe following electronic databases will be searched: Medline, Embase, The Cochrane Library, PubMed, Cumulative Index of Nursing and Allied Health Literature Plus, Web of Science, grey literature (Google Scholar) and several trial registries. Search strategies will be designed to identify human adult (≥18) randomised (and non-randomised) controlled trials, prospective and retrospective cohort studies, and case–control studies concerning ‘sex-specific differences associated with the efficacy of antihypertensive treatment’. A preliminary search strategy was developed for Medline (1946—16 September 2019). Two investigators will independently review each article included in the final analysis. Primary outcomes investigated are cardiovascular morbidity and mortality and systolic and diastolic blood pressure. Pooled analyses will be conducted using the random-effects model. Publication bias will be assessed by visual inspection of funnel plots and by Begg’s and Egger’s statistical tests. Between-studies heterogeneity will be measured using the I2test (p<0.10). Sources of heterogeneity will be explored by sensitivity, subgroup and metaregression analyses.Ethics and disseminationThis is the first meta-analysis that will comprehensively compare the efficacy of antihypertensive treatment regimens between men and women. Findings will be shared through scientific conferences and societies, social media and consumer advocacy groups. Results will be used to inform the current guidelines for management of hypertension in men and women by demonstrating the importance of implementing sex-specific recommendations. Ethical considerations are not applicable for this protocol.

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The implications of blood pressure targets from the 2018 European Society of Cardiology hypertension guidelines in Asian patients: a systematic review and meta-analysis

Annals of Saudi Medicine ◽

10.5144/0256-4947.2020.234 ◽

2020 ◽

Vol 40 (3) ◽

pp. 234-254

Author(s):

Akhmetzhan Maratovich Galimzhanov ◽

Yersyn Toleutayevich Sabitov ◽

Baurzhan Slymovich Azizov

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

European Society ◽

Meta Analysis ◽

Blood Pressure Targets ◽

Asian Patients ◽

Hypertension Guidelines ◽

European Society Of Cardiology

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A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/s12630-017-0877-1 ◽

2017 ◽

Vol 64 (7) ◽

pp. 703-715 ◽

Cited By ~ 9

Author(s):

Mathieu Hylands ◽

Morten Hylander Moller ◽

Pierre Asfar ◽

Augustin Toma ◽

Anne Julie Frenette ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Critically Ill ◽

Blood Pressure Targets ◽

Critically Ill Adults ◽

Ill Adults

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Does the benefit from treating to lower blood pressure targets vary with age? A systematic review and meta-analysis

Journal of Hypertension ◽

10.1097/hjh.0000000000002079 ◽

2019 ◽

Vol 37 (8) ◽

pp. 1558-1566 ◽

Cited By ~ 3

Author(s):

George C. Roush ◽

Ayla Zubair ◽

Kevin Singh ◽

William J. Kostis ◽

Domenic A. Sica ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Meta Analysis ◽

Lower Blood Pressure ◽

Blood Pressure Targets ◽

Lower Blood

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The effectiveness of Baduanjin exercise for hypertension: a systematic review and meta-analysis of randomized controlled trials

BMC Complementary Medicine and Therapies ◽

10.1186/s12906-020-03098-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Bao-yi Shao ◽

Xia-tian Zhang ◽

Robin W. M. Vernooij ◽

Qiu-yi Lv ◽

Yao-yang Hou ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Randomized Controlled Trials ◽

Subgroup Analysis ◽

Meta Analysis ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Controlled Trials ◽

Randomized Controlled ◽

Cardiovascular Morbidity And Mortality

Abstract Background Hypertension, a major risk factor of cardiovascular mortality, is a critical issue for public health. Although Baduanjin (Eight Brocades, EB), a traditional Chinese exercise, might influence blood pressure, glucose, and lipid status, the magnitude of true effects and subgroup differences remains unclear. Therefore, we performed a systematic review of relevant randomized controlled trials (RCTs) to evaluate the effect of EB on patient-important outcomes. Methods We systematically searched PubMed, the Cochrane Library, Web of Science, and Chinese databases since inception until March 30, 2020. Meta-analysis was carried out using “meta” package in R 3.4.3 software. A prespecified subgroup analysis was done according to the type of comparisons between groups, and the credibility of significant subgroup effects (P < 0.05) were accessed using a five-criteria list. A GRADE evidence profile was constructed to illustrate the certainty of evidence. Results Our meta-analysis, including 14 eligible trials with 1058 patients, showed that compared with routine treatment or health education as control groups, the mean difference (MD) in systolic blood pressure (SBP) of the EB groups was − 8.52 mmHg (95%CI:[− 10.65, − 6.40], P < 0.01) and diastolic blood pressure (DBP) was − 4.65 mmHg (95%CI: [− 6.55, − 2.74], P < 0.01). For blood pressure, the evidence was, however, of low certainty because of risk of bias and inconsistency, and for the outcomes of most interest to patients (cardiovascular morbidity and mortality directly), of very low certainty (measurement of surrogate only). Subgroup analysis showed there was no significant interaction effect between different type of comparisons (SBP P = 0.15; DBP P = 0.37), so it could be easily attributed to chance. Conclusion Regularly EB exercising may be helpful to control blood pressure, but the evidence is only low certainty for blood pressure and very low certainty for cardiovascular morbidity and mortality. Rigorously designed RCTs that carry out longer follow-up and address patient-important outcomes remain warranted. Trial registration PROSPERO Registration number: CRD42018095854.

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Differences in Coronary Blood Flow in Aortic Regurgitation and Systemic Arterial Hypertension Have Implications for Diastolic Blood Pressure Targets: A Systematic Review and Meta-Analysis

Clinical Cardiology ◽

10.1002/clc.22194 ◽

2013 ◽

Vol 36 (12) ◽

pp. 728-736 ◽

Cited By ~ 3

Author(s):

Simon W. Rabkin

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Blood Flow ◽

Arterial Hypertension ◽

Diastolic Blood Pressure ◽

Aortic Regurgitation ◽

Coronary Blood Flow ◽

Meta Analysis ◽

Blood Pressure Targets ◽

Systemic Arterial Hypertension

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Management of Patient Care in Hemodialysis While Focusing on Cardiovascular Disease Events and the Atypical Role of Hyper- and/or Hypotension: A Systematic Review

BioMed Research International ◽

10.1155/2016/9710965 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 3

Author(s):

Amjad Khan ◽

Amer Hayat Khan ◽

Azreen Syazril Adnan ◽

Syed Azhar Syed Sulaiman ◽

Siew Hua Gan ◽

...

Keyword(s):

Systematic Review ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cardiovascular Events ◽

Myocardial Dysfunction ◽

Hemodialysis Patients ◽

Morbidity And Mortality ◽

Published Data ◽

Atherosclerotic Cardiovascular Disease

Background. Hemodialysis related hemodynamic instability is a major but an underestimated issue. Moreover, cardiovascular events are the leading cause of morbidity and mortality associated with blood pressure in hemodialysis patients. However, there have been many controversies regarding the role and management of hyper- and/or hypotension during hemodialysis that needs to be addressed.Objective. To critically review the available published data on the atypical role of hyper- and/or hypotension in cardiovascular associated morbidity and mortality in patients on hemodialysis and to understand the discrepancies in this context.Methods. A comprehensive search of literature employing electronic as well as manual sources and screening 2783 papers published between Jan 1980 and Oct 2015 was conducted to collect, identify, and analyze relevant information through peer-reviewed research articles, systematic reviews, and other published works. The cardiovascular events, including accelerated atherosclerotic cardiovascular disease (ASCVD), stroke, heart failure, myocardial infarction, myocardial ischemia, and stress induced myocardial dysfunction, leading to death were considered relevant.Results. A total of 23 published articles met the inclusion criteria and were included for in-depth review and analysis to finalize a comprehensive systematic review article. All the studies showed a significant association between the blood pressure and cardiovascular disease events in hemodialysis patients.Conclusions. Both intradialytic hypertension/hypotension episodes are major risk factors for cardiovascular mortality with a high percentage of probable causality; however, clinicians are faced with a dilemma on how to evaluate blood pressure and treat this condition.

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