Evidence map›Paper›PMID 28109971›Full record

ArticleThe American journal of medicine2017

Optimal Systolic Blood Pressure Target After SPRINT: Insights from a Network Meta-Analysis of Randomized Trials.

Sripal Bangalore, Bora Toklu, Eugenia Gianos, Arthur Schwartzbard, Howard Weintraub, Gbenga Ogedegbe, Franz H Messerli

Open access · bronzeAbstract readNetwork Meta-Analysis
PubMed Publisher
In one paragraph

Article in The American journal of medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 76 papers, 16 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
76citing papers in PubMed, 16 pooled it
17.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

76 citing papers in PubMed, 16 syntheses or guidelines pooled it, 179 citations in OpenAlex.

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  5. Blood pressure targets in adults with hypertension.The Cochrane database of systematic reviews · 2020
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  11. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019).Hypertension research : official journal of the Japanese Society of Hypertension · 2019
    Guideline
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  13. Optimal blood pressure targets for patients with hypertension: a systematic review and meta-analysis.Hypertension research : official journal of the Japanese Society of Hypertension · 2019
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16 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 2 countries.

Sripal BangaloreDivision of Cardiology, New York University School of Medicine, New York, NY. Electronic address: sripalbangalore@gmail.com.
Bora TokluDivision of Cardiology, Mount Sinai Beth Israel Medical Center, New York, NY.
Eugenia GianosDivision of Cardiology, New York University School of Medicine, New York, NY.
Arthur SchwartzbardDivision of Cardiology, New York University School of Medicine, New York, NY.
Howard WeintraubDivision of Cardiology, New York University School of Medicine, New York, NY.
Gbenga OgedegbeDivision of Cardiology, New York University School of Medicine, New York, NY.
Franz H MesserliDivision of Cardiology, University Hospital, Bern, Switzerland; Division of Cardiology, Mount Sinai, Icahn School of Medicine, New York, NY.
New York University · USMount Sinai Beth Israel · USUniversity Hospital of Bern · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe optimal on-treatment blood pressure (BP) target has been a matter of debate. The recent SPRINT trial showed significant benefits of a BP target of <120 mm Hg, albeit with an increase in serious adverse effects related to low BP.

methodsPubMed, EMBASE, and CENTRAL were searched for randomized trials comparing treating with different BP targets. Trial arms were grouped into 5 systolic BP target categories: 1) <160 mm Hg, 2) <150 mm Hg, 3) <140 mm Hg, 4) <130 mm Hg, and 5) <120 mm Hg. Efficacy outcomes of stroke, myocardial infarction, death, cardiovascular death, heart failure, and safety outcomes of serious adverse effects were evaluated using a network meta-analysis.

resultsSeventeen trials that enrolled 55,163 patients with 204,103 patient-years of follow-up were included. There was a significant decrease in stroke (rate ratio [RR] 0.54; 95% confidence interval [CI], 0.29-1.00) and myocardial infarction (RR 0.68; 95% CI, 0.47-1.00) with systolic BP <120 mm Hg (vs <160 mm Hg). Sensitivity analysis using achieved systolic BP showed a 72%, 97%, and 227% increase in stroke with systolic BP of <140 mm Hg, <150 mm Hg, and <160 mm, respectively, when compared with systolic BP <120 mm Hg. There was no difference in death, cardiovascular death, or heart failure when comparing any of the BP targets. However, the point estimate favored lower BP targets (<120 mm Hg, <130 mm Hg) when compared with higher BP targets (<140 mm Hg or <150 mm Hg). BP targets of <120 mm Hg and <130 mm Hg ranked #1 and #2, respectively, as the most efficacious target. There was a significant increase in serious adverse effects with systolic BP <120 mm Hg vs <150 mm Hg (RR 1.83; 95% CI, 1.05-3.20) or vs <140 mm Hg (RR 2.12; 95% CI, 1.46-3.08). BP targets of <140 mm Hg and <150 mm Hg ranked #1 and #2, respectively, as the safest target for the outcome of serious adverse effects. Cluster plots for combined efficacy and safety showed that a systolic BP target of <130 mm Hg had optimal balance between efficacy and safety.

conclusionsIn patients with hypertension, a on-treatment systolic BP target of <130 mm Hg achieved optimal balance between efficacy and safety.

Indexed as

Antihypertensive AgentsBlood PressureCardiovascular DiseasesHeart FailureHumansHypertensionMyocardial InfarctionRandomized Controlled Trials as TopicStrokeAntihypertensive AgentsBlood pressureMyocardial infarctionStrokeSystolicTarget

Identifiers

PMID28109971
OpenAlexW2579221121

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.