HypertensionSecondary analysis
Systolic Blood Pressure Targets in Patients With Hypertension With and Without Cardiovascular Disease: A Pooled Analysis of 4 Randomized Clinical Trials
- secondary analysis of individual-level data from 4 clinical trials
- pooled analysis of 4 randomized clinical trials
- stratified Cox proportional hazards models
- stratified by study trials
Authors' conclusion
Restricted cubic spline analyses demonstrated a J-shaped association between achieved SBP and major adverse cardiovascular event irrespective of CVD history. Maintaining SBP within 110 to 140 mm Hg was similarly associated with lower cardiovascular risk in patients with and without CVD. Risk appeared lowest when SBP was between 120 and 130 mm Hg, while an SBP target <110 mm Hg may offer additional benefit among patients without CVD.
Study context
- Population
- Patients with hypertension with and without cardiovascular disease (CVD); participants aged >80 years, with prevalent heart failure, or with missing follow-up systolic blood pressure (SBP) measurements or CVD history excludedparticipants included in the analysis · history of CVD 24,524
- Participants
- 59,727 patients
- Comparison
- Associations between time-in-target range (TTR) and major adverse cardiovascular events, per 10% increase in TTR, analyzed separately by CVD history
- with CVDn = 24,524
Primary result
As reported in the abstract
Major adverse cardiovascular events, SBP 110 to 120 mm Hg
per 10% increase in TTR vs Lower TTR within the same targetHazard ratio (95% CI)
without CVD
0.89(0.86–0.92)
with CVD
0.93(0.90–0.95)
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Major adverse cardiovascular events, SBP 120 to 130 mm Hg — per 10% increase in TTR vs Lower TTR within the same target · without CVD | 0.86 (0.83–0.88) | |
| Major adverse cardiovascular events, SBP 120 to 130 mm Hg — per 10% increase in TTR vs Lower TTR within the same target · with CVD | 0.90 (0.88–0.92) | |
| Major adverse cardiovascular events, SBP 130 to 140 mm Hg — per 10% increase in TTR vs Lower TTR within the same target · without CVD | 0.94 (0.92–0.96) | |
| Major adverse cardiovascular events, SBP 130 to 140 mm Hg — per 10% increase in TTR vs Lower TTR within the same target · with CVD | 0.93 (0.91–0.95) | |
| Major adverse cardiovascular events, SBP <110 mm Hg — per 10% increase in TTR vs Lower TTR within the same target · without CVD | 0.91 (0.86–0.97) | |
| Major adverse cardiovascular events, SBP <110 mm Hg — per 10% increase in TTR vs Lower TTR within the same target · with CVD | 1.02 (0.98–1.06) | |
| 0.512Hazard ratio (log scale) |
Major adverse cardiovascular events, SBP ≥150 mm Hg
- SBP ≥150 mm Hg was associated with increased major adverse cardiovascular event risk in both groups
Baseline characteristics
- mean age
- 65.8 (SD, 6.9) years
- men
- 52.3%
- history of CVD
- 24 524 (41.1%)
Original publication
Systolic Blood Pressure Targets in Patients With Hypertension With and Without Cardiovascular Disease: A Pooled Analysis of 4 Randomized Clinical Trials. Circ Popul Health Outcomes. Published 24 February 2026. doi:10.1161/circoutcomes.125.012643
Summarised from the published abstract; every number is checked against it