| Study | Intervention and comparison | Population | Outcomes | Comments |
|---|---|---|---|---|
|
Brunström 201841 (systematic review of RCTs) |
Systolic blood pressure thresholds: <140 (n=68,966) 140–159 (n=43,889) ≥160 mmHg (n=79,940) Treatment versus no treatment | Adults with hypertension, with and without diabetes (n=192,795) |
At 4 years: All-cause mortality Stroke Coronary heart disease Heart failure | Study downgraded for very serious indirectness as the population included coronary artery disease (CAD), mixed CVD and post-stroke. Also, the review included studies that pooled low intensity treatment and no treatment arms (16% of study population). |
|
Law 2009107 (systematic review of RCTs and non-randomised studies) |
Diastolic blood pressure thresholds: >80 (n=42,599) 80–84 (n=37,516) 85–89 (n=39,731) 90–94 (n=38,646) >95 (n=6,195) Treatment versus no treatment. | Adults with hypertension, with and without diabetes (n=464,000; multiple comparisons, actual number of participants included within the diastolic thresholds analysis: n=164,687) |
At 4 years: Stroke Coronary heart disease | Study downgraded for very serious indirectness as the population included CAD, mixed CVD and post-stroke. Also, review included studies that pooled low intensity treatment and no treatment arms. |
|
Sheppard 2018155 (cohort study) |
Systolic blood pressure threshold of 140–159 mmHg with a low cardiovascular risk (mean cardiovascular risk threshold of 8%; QRISK2) Treatment versus no treatment | Adults with hypertension, without diabetes (n=38,286) |
At 5.8 years: Mortality Stroke Heart failure MI Non-MI acute coronary syndrome Hypotension Acute Kidney Injury |
Participants with previous cardiovascular events were excluded from the trial 7,720 participants (20.2%) included in the main analysis had a previous risk score recorded, and an additional 9,096 (23.8%) had available risk factor information to calculate a QRISK2 score. For the remaining 21,050 (56%), cardiovascular risk was estimated by inserting age- and sex-standardised mean cholesterol values and Townsend scores from the Health Survey for England into the algorithm to replace missing data. Downgraded for indirectness because 41.6% of the non-treatment arm were on treatment at some point in the trial. Some QRISK2 inputs were also not available in all participants and were imputed (estimated 56% of the population had some form of imputation). The mean diastolic blood pressure was also 88.5 (standard deviation [SD] 5.2) mmHg, which is less than the diastolic threshold for stage 1 hypertension. |
|
Sundstrom 2015162 (IPD) |
Systolic blood pressure threshold of 140–159 mmHg Treatment versus no treatment | Adults with hypertension and type 2 diabetes (n=6361) |
At 4.4 years: All-cause mortality Stroke Heart failure |
RCTs where at least 80% of participants had grade 1 hypertension and had no previous cardiovascular disease were included. To note that risk of bias for individual studies included within the review was not available. The ROBIS checklist (assessing the quality of the systematic review itself) was therefore incorporated into the GRADE assessments for overall quality assessment per outcome. |
From: Evidence review for initiating treatment
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