SynthesisPLoS medicine2012
Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: a systematic review and meta-analysis.
Synthesis in PLoS medicine, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 10 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
47 citing papers in PubMed, 10 syntheses or guidelines pooled it.
- Angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers for preventing the progression of diabetic kidney disease.The Cochrane database of systematic reviews · 2024Pooled it
- Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.The Cochrane database of systematic reviews · 2022Pooled it
- Blood pressure targets in adults with hypertension.The Cochrane database of systematic reviews · 2020Pooled it
- Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.The Cochrane database of systematic reviews · 2020Pooled it
- Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.The Cochrane database of systematic reviews · 2018Pooled it
- Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Journal of the American College of Cardiology · 2018Pooled it
- Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.The Cochrane database of systematic reviews · 2017Pooled it
- The lower, the better? : fractional polynomials meta-regression of blood pressure reduction on stroke risk.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2013Pooled it
- Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2013Pooled it
- 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 medicinePooled it
- Effects of Blood Pressure Lowering on Clinical Outcomes According to Baseline Blood Pressure and Cardiovascular Risk in Patients With Type 2 Diabetes Mellitus.Hypertension (Dallas, Tex. : 1979) · 2019Trial
- Spironolactone is superior to hydrochlorothiazide for blood pressure control and arterial stiffness improvement: A prospective study.Medicine · 2018Trial
- Hypertensive Heart Failure with Preserved Ejection Fraction: Guidelines vs. Randomized Controlled Trials Evidence Gaps.Medicina (Kaunas, Lithuania) · 2026Review
- The association between increases in nitrate in drinking water and colorectal cancer incidence rates in California, USA.Cancer causes & control : CCC · 2025Article
- Church-Sponsored Promotornan di Salú/Community Health Worker-Led Health Fair Promoting Hypertension Awareness in Willemstad, Curaçao: A Pilot Study Assessing Participant Satisfaction and Experience.International journal of environmental research and public health · 2025Article
- Blood pressure levels and risk of end-stage renal disease in patients with type 2 diabetes who underwent percutaneous coronary intervention: a nationwide population-based study.Scientific reports · 2025Article
- Article
- Coronary artery calcification in patients with advanced chronic kidney disease.BMC cardiovascular disorders · 2022Article
- Associations of zinc-α-2-glycoprotein with metabolic syndrome and its components among adult Arabs.Scientific reports · 2022Article
- Exploring Feasibility of mHealth to Manage Hypertension in Rural Black Older Adults: A Convergent Parallel Mixed Method Study.Patient preference and adherence · 2022Article
Corrections and comments
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGuidelines recommend intensive blood pressure (BP) lowering in patients at high risk. While placebo-controlled trials have demonstrated 22% reductions in coronary heart disease (CHD) and stroke associated with a 10-mmHg difference in systolic BP, it is unclear if more intensive BP lowering strategies are associated with greater reductions in risk of CHD and stroke. We did a systematic review to assess the effects of intensive BP lowering on vascular, eye, and renal outcomes. METHODS AND
findingsWe systematically searched Medline, Embase, and the Cochrane Library for trials published between 1950 and July 2011. We included trials that randomly assigned individuals to different target BP levels. We identified 15 trials including a total of 37,348 participants. On average there was a 7.5/4.5-mmHg BP difference. Intensive BP lowering achieved relative risk (RR) reductions of 11% for major cardiovascular events (95% CI 1%-21%), 13% for myocardial infarction (0%-25%), 24% for stroke (8%-37%), and 11% for end stage kidney disease (3%-18%). Intensive BP lowering regimens also produced a 10% reduction in the risk of albuminuria (4%-16%), and a trend towards benefit for retinopathy (19%, 0%-34%, p = 0.051) in patients with diabetes. There was no clear effect on cardiovascular or noncardiovascular death. Intensive BP lowering was well tolerated; with serious adverse events uncommon and not significantly increased, except for hypotension (RR 4.16, 95% CI 2.25 to 7.70), which occurred infrequently (0.4% per 100 person-years).
conclusionsIntensive BP lowering regimens provided greater vascular protection than standard regimens that was proportional to the achieved difference in systolic BP, but did not have any clear impact on the risk of death or serious adverse events. Further trials are required to more clearly define the risks and benefits of BP targets below those currently recommended, given the benefits suggested by the currently available data.
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