Effect of intensive lowering of systolic blood pressure treatment on heart failure events: a meta-analysis of randomized controlled studies

We performed this meta-analysis to assess the association between intensive systolic blood pressure (SBP)-lowering strategies and heart failure (HF). A comprehensive literature review was conducted using English and Chinese databases from their origination through April 2018. Random-effects models were used to calculate pooled relative risks and 95% confidence intervals. Nine randomized controlled trials including a total of 39,936 hypertensive patients were ultimately included in our meta-analysis. Pooled analysis of these nine trials showed that a treatment target of SBP ≤140 mmHg was associated with a significant reduction in HF risk (RR: 0.73, 95%CI: 0.62–0.87). Furthermore, the pooled analysis of prospective randomized controlled trials indicated a significant association between intensive lowering of SBP and HF risk (RR: 0.75, 95%CI: 0.62–0.90) and showed that intensive lowering of SBP could decrease risk of HF in patients without diabetes mellitus (RR: 0.69, 95%CI: 0.52–0.91) and in those ≥65 years old (RR: 0.72, 95%CI: 0.56–0.93), but this finding was not shown for patients with diabetes mellitus (RR: 0.81, 95%CI: 0.56–1.19) or in those <65 years old (RR: 0.81, 95%CI: 0.56–1.19). When intensive lowering of SBP achieved an SBP ≤ 120 mmHg, a pooled analysis indicated a positive association between SBP and HF risk (RR: 0.75, 95%CI: 0.63–0.89), and a pooled analyses showed that intensive lowering of SBP could decrease risk of HF in patients without diabetes mellitus (RR: 0.71, 95%CI: 0.51–0.98) and in those ≥65 years old (RR: 0.76, 95%CI: 0.58–0.98); however, this result was not found for patients with diabetes mellitus (RR: 0.81, 95%CI: 0.56–1.19) or those <65 years old (RR: 0.81, 95%CI: 0.56–1.19). The existing data support the results of a positive association between intensive SBP-lowering treatment and HF risk, especially for those patients without diabetes and those older than 65 years. However, additional prospective studies are still needed to confirm these associations.