Table 2.
Clinical Outcome Trials Comparing Blood Pressure Targets
| Trials Comparing SBP Target < 150 mmHg | |||||
|---|---|---|---|---|---|
| Trial Name | Age Range | Race/Ethnic # | BP Entry Criteria | Intervention | Findings |
| SHEP[29] | >60 years (mean age 72) |
Blacks 657 Whites 4,079 |
SBP: 160–219 DBP: <100 |
THZD ± BB vs placebo | Achieved SBP: 143 vs. 155 mmHg CVD death ↓ 14%, p=0.026) Total CVA↓ 36% |
| Sys-Eur [58] | > 60 (mean age 70.3) |
Europeans 4,695 | SBP: 160–219 DBP: <95 |
CCB ± ACEI ± THZ vs placebo | Achieved SBP: 151 vs. 161 mmHg CVA ↓ 42% (p = 0.003) Fatal and nonfatal CVD ↓ 26% (p = 0.03) |
| HYVET[19] | 80–105 years (mean age 83.6) |
W. Europeans 86 E. Europeans 2,144 Chinese 1,526 Australasian 19 Tunisian 70 |
SBP: > 160 | THZ ± ACEI vs placebo | Achieved SBP: 143.5 vs. 158.0 mmHg Fatal and nonfatal CVA↓ 30% (p = 0.06) Fatal stroke ↓ 39% (p = 0.05) HF↓ 64% CVD mortality↓23% (p < 0.001), Total death ↓21% (p = 0.02) |
| Trials Comparing SBP Target < 140 mmHg | |||||
| JATOS[34] | 65 to 85 years (mean age 73.6) |
Japanese 4,418 | SBP: >160 DBP: <120 |
SBP <140 vs. SBP >140 to <160 mmHg |
Achieved SBP: 135.9 vs. 145.6 mmHg No difference CVD No difference in AEs |
| VALISH[33] | ≥ 70 and < 85 (mean age 76) |
Japanese 3,260 | SBP: >160 DBP: <90 |
SBP <140 vs. SBP >140 to <150 mmHg |
Achieved SBP: 136.6 vs. 142.0 mmHg No differences in CVD No difference in AEs |
| Cardio-Sis[32] | > 55 (mean age 67.7) |
Italians 1,111 | SBP: >150 | SBP <130 vs. SBP(<140 mm Hg |
Achieved SBP: 131.6 vs. 135.6 mmHg LVH ↓ 39% (p=0.0008) CVD ↓ 50% (p=0.003) |
| Trials Comparing SBP Target < 140 mmHg compare to SBP target < 120 mmHg | |||||
| ACCORD[59] | > 40 to 79 years (mean age 62.2) |
Blacks 1,142 Whites 2,864 Hispanic 330 |
SBP: 130–180 | Antihypertensive drug treatment to either: SBP<120 mmHg (Intensive) vs. SBP < 140 mm Hg (Standard) |
Achieved SBP: 119 mmHg vs. 134 mmHg No differences in primary composite outcomes or CVD death |
| SPRINT[30] | > 50 (mea age 67.9) |
Blacks 2,802 Whites 5,399 Hispanic 984 Other 176 |
SBP: 130–180 | Open-label, various antihypertensive use in two SBP treatment arms: Intensive arm (<120 mm Hg) or Standard arm (<140 mm Hg) |
Trial in progress. |
Clinical Trial Acronyms: 1) ACCORD= The Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure trial (ACCORD BP); 2) Cardio-Sis = Italian Study on the Cardiovascular Effects of Systolic Blood Pressure Control; 3) HYVET = Hypertension in the Very Elderly Trial; 4) JATOS = Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly; 5) SHEP = The Systolic Hypertension in the Elderly Program; 6) Sys-Eur = The Systolic Hypertension in Europe; 7) VALISH = Valsartan in Elderly Isolated Systolic Hypertension Study; 8) SPRINT = The Systolic Blood Pressure Intervention Trial. Thiazide-type diuretic (THZD), beta blocker (BB), calcium channel blocker (CCB), angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB).