Summary of findings for the main comparison.
Lower blood pressure targets compared with standard blood pressure targets for mortality and morbidity
| Lower blood pressure targets compared with standard blood pressure targets for mortality and morbidity | ||||||
| Patient or population: Cardiovascular disease with high blood pressure Setting: Outpatients (average duration of trials 4 years) Intervention: Lower blood pressure targets (≤135/85 mmHg) Comparison: Standard blood pressure targets (≤140 to 160/90 to 100 mmHg) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with standard blood pressure target | Risk with lower blood pressure target | |||||
| Total mortality | Study population | RR 1.05 (0.90 to 1.22) | 9795 (6 RCTs) | ⊕⊕⊕⊝ MODERATE 1 | ||
| 68 per 1000 | 71 per 1000 (61 to 83) | |||||
| Serious adverse events | Study population | RR 1.02 (0.95 to 1.11) | 9795 (6 RCTs) | ⊕⊕⊝⊝ LOW 1,2 | ||
| 186 per 1000 | 189 per 1000 (177 to 206) | |||||
| Total cardiovascular events | Study population | RR 0.87 (0.78 to 0.98) | 9795 (6 RCTs) | ⊕⊕⊝⊝ LOW 1,3 | ARR = 1.6% over 4 years (0.2% to 2.7%) NNTB = 63 over 4 years (37 to 500) |
|
| 123 per 1000 | 107 per 1000 (96 to 121) | |||||
| Cardiovascular mortality | Study population | RR 0.96 (0.77 to 1.21) |
9795 (6 RCTs) |
⊕⊕⊕⊝ MODERATE 1 | ||
| 32 per 1000 | 30 per 1000 (24 to 38) |
|||||
|
Withdrawals due to adverse effects |
Study population | RR 8.16 (2.06 to 32.28) | 690 (2 RCT) | ⊕⊝⊝⊝ VERY LOW 1,4 | ||
| 7 per 1000 | 60 per 1000 (15 to 239) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; ARR: attributed risk ratio; NNTB: number needed to treat for an additional beneficial outcome | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded one level due to serious imprecision (95% CI is wider than the minimal important difference).
2 Downgraded one level due to incomplete available data.
3 Downgraded one level due to high risk of bias.
4 Downgraded two levels because only two of the smaller studies reported this outcome.