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Patient selection and treatment targets for blood pressure (BP) reduction remain controversial, particularly among patients with high-normal BP and without previous cardiovascular (CV) disease. Researchers combined patient-level data from 48 large randomized, controlled trials (344,000 total patients) in which BP-lowering medications were compared with placebo or with one another, or in which more-intensive versus less-intensive treatment regimens were evaluated. Trials that were done exclusively in patients with heart failure were excluded. Twenty percent of patients with previous CV disease and 8% of patients without previous CV disease had baseline systolic BP <130 mm Hg.
After a median 4 years of follow-up, reduction of systolic BP by 5 …