Lancet
Intensive BP control yields net CV benefit despite increased adverse events
Intensive SBP lowering confers a net clinical benefit by reducing major CV events, but at the cost of increased adverse and renal events. These findings support guideline recommendations for intensive BP control in appropriate patients, while underscoring the need for individualized risk assessment and close monitoring for adverse effects.
Study details: This individual participant data analysis pooled six major randomized trials (ACCORD BP, SPRINT, ESPRIT, BPROAD, STEP, CRHCP) comprising 80,220 adults (median age, 64; 51% female; predominantly Asian and White) with hypertension. Participants were randomized to intensive SBP targets (<120 or <130 mm Hg) vs. standard targets (<140 or <150 mm Hg, or usual care).
Results:
- Intensive BP control reduced composite CV events (hazard ratio [HR], 0.76; 95% credible interval [CrI], 0.72–0.81), with an absolute risk reduction of 1.73% (number needed to treat 58).
- Adverse events, including renal-related events, increased by 1.82% (number needed to harm 55) with intensive treatment.
- The net benefit, adjudicated by weighting, remained positive (HR, 1.14; 95% CrI, 1.03–1.25) and was similar when kidney events were included (HR, 1.13; 95% CrI, 1.01–1.24).
Source:
Guo X; BPRULE Study Group, et al. (2025, August 31). Lancet. Benefit-harm trade-offs of intensive blood pressure control versus standard blood pressure control on cardiovascular and renal outcomes: an individual participant data analysis of randomised controlled trials. https://pubmed.ncbi.nlm.nih.gov/40902616/