title: Tight versus standard blood pressure control in patients with hypertension with and without cardiovascular disease.
abstract: An excessive blood pressure (BP) reduction might be dangerous in high-risk patients with cardiovascular disease. In the Studio Italiano Sugli Effetti CARDIOvascolari del Controllo della Pressione Arteriosa SIStolica (Cardio-Sis), 1111 nondiabetic patients with systolic BP ≥150 mm Hg were randomly assigned to a systolic BP target <140 mm Hg (standard control) or <130 mm Hg (tight control). We stratified patients by absence (n=895) or presence (n=216) of established cardiovascular disease at entry. Antihypertensive treatment was open-label and tailored to each patient's needs. After 2-year follow-up, the primary end point of the study, electrocardiographic left ventricular hypertrophy, occurred less frequently in the tight than in the standard control group in the patients without (10.8% versus 15.2%) and with (14.1% versus 23.5%) established cardiovascular disease (P for interaction=0.82). The main secondary end point, a composite of cardiovascular events and all-cause death, occurred less frequently in the tight than in the standard control group both in patients without (1.47 versus 3.68 patient-years; P=0.016) and with (7.87 versus 11.22 patient-years; P=0.049) previous cardiovascular disease. In a multivariable Cox model, allocation to tight BP control reduced the risk of cardiovascular events to a similar extent in patients with or without overt cardiovascular disease at randomization (P for interaction=0.43). In conclusion, an intensive treatment aimed to lower systolic BP<130 mm Hg reduced left ventricular hypertrophy and improved clinical outcomes to a similar extent in patients with hypertension and without established cardiovascular disease.
authors.affiliation: Hospital of Assisi, Department of Medicine, Via Valentin Müller, 1. 06081 - Assisi, Italy. verdec@tin.it.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Reboldi
authors.forename: Fabio
authors.initials: F
authors.lastname: Angeli
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents
keywords: hypertension; hypertrophy, left ventricular; myocardial infarction; prognosis; randomized controlled trial; stroke