title: A Randomized Trial of Intensive versus Standard Blood-Pressure Control.
abstract: BACKGROUND
  The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain.
  
  
  METHODS
  We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes.
  
  
  RESULTS
  At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs. 2.19% per year; hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001). All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensive-treatment group than in the standard-treatment group.
  
  
  CONCLUSIONS
  Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01206062.).
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.forename: Jeff D
authors.initials: JD
authors.lastname: Williamson
authors.forename: Paul K
authors.initials: PK
authors.lastname: Whelton
authors.forename: Joni K
authors.initials: JK
authors.lastname: Snyder
authors.forename: Kaycee M
authors.initials: KM
authors.lastname: Sink
authors.forename: Michael V
authors.initials: MV
authors.lastname: Rocco
authors.forename: David M
authors.initials: DM
authors.lastname: Reboussin
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.forename: Paul L
authors.initials: PL
authors.lastname: Kimmel
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Fine
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cutler
authors.forename: William C
authors.initials: WC
authors.lastname: Cushman
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Cheung
authors.forename: Walter T
authors.initials: WT
authors.lastname: Ambrosius
mesh_terms: D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002423:Cause of Death; D005260:Female; D006040:Goals; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents