Luis Carlos Saiz, Javier Gorricho, Javier Garjón, Maria Concepción Salaya, Juan Erviti, Leire Leache

Key messages

The evidence identified in this review does not support lower blood pressure goals over standard goals in people with high blood pressure (also known as hypertension) and heart or vascular (blood vessels and circulatory system) problems. More new trials are needed to examine this question.

What is high blood pressure?

Hypertension (high blood pressure) is a long‐term condition that increases the risk of health problems such as heart attack, stroke, or kidney disease. 

How is high blood pressure treated?

Many people with heart or vascular problems also have high blood pressure. Some clinical guidelines recommend a lower blood pressure goal (135/85 mmHg or lower) for people with high blood pressure and previous heart or vascular problems than for with those without (140 mmHg to 160 mmHg or less systolic (pressure when heart pumps blood around the body) and 90 mmHg to 100 mmHg diastolic or less (pressure when heart rests between beats) are standard blood pressure goals). It is unclear whether lower goals lead to overall health benefits. 

What did we want to find out?

We wanted to find out if lower blood pressure goals are better than standard blood pressure goals for people with high blood pressure who also have heart or vascular problems. 

What did we do?

We searched for studies that compared lower blood pressure targets to standard blood pressure targets in people with high blood pressure and a history of cardiovascular disease (heart disease, angina, stroke, vascular disease). Studies had to talk about results such as deaths or other events caused by diseases of the heart or the blood vessels, such as heart attack, stroke, or heart failure. Studies could also talk about other types of health‐related side effects. We only chose randomized studies (where people were randomly put into one of two or more treatment groups) with 50 or more people in each group and that lasted at least six months. 

What did we find?

In this update, we found one new study giving a total of seven studies with 9595 people included in the review. We found little to no difference in total numbers of deaths, or heart or vascular deaths between lower and standard blood pressure goals. There was also little to no difference for the total number of heart or vascular problems and total serious harms, but the evidence was less certain. 

What are the limitations of the evidence?

Based on uncertainty and limited information, we found more people dropped out of the trials because of medicine‐related harms in the lower blood pressure target group and no overall health benefit among people in the lower target group. 

How up to date is this evidence?

This is the third update of a review first published in 2017. The evidence is up to date to January 2022.