Treatment blood pressure targets for hypertension

  • Review
  • Intervention


  • Jose Agustin Arguedas,

    Corresponding author
    1. Universidad de Costa Rica, Depto de Farmacologia Clinica, Facultad de Medicina, San Pedro de Montes de Oca, Costa Rica
    • Jose Agustin Arguedas, Depto de Farmacologia Clinica, Facultad de Medicina, Universidad de Costa Rica, San Pedro de Montes de Oca, Costa Rica.

    Search for more papers by this author
  • Marco I Perez,

    1. University of British Columbia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver, BC, Canada
    Search for more papers by this author
  • James M Wright

    1. University of British Columbia, Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver, BC, Canada
    Search for more papers by this author



When treating elevated blood pressure, doctors need to know what blood pressure (BP) target they should try to achieve. The standard of clinical practice for some time has been ≤ 140 - 160/ 90 - 100 mmHg. New guidelines are recommending BP targets lower than this standard. It is not known whether attempting to achieve targets lower than the standard reduces mortality and morbidity.


To determine if lower BP targets (≤ 135/85 mmHg) are associated with reduction in mortality and morbidity as compared with standard BP targets (≤ 140-160/ 90-100 mmHg).

Search methods

Electronic search of MEDLINE (1966-2008), EMBASE (1980-2008), and CENTRAL (up to June 2008); references from review articles, clinical guidelines, and clinical trials.

Selection criteria

Randomized controlled trials comparing patients randomized to lower or to standard BP targets and providing data on any of the primary outcomes below.

Data collection and analysis

Two reviewers (JAA, MIP) independently assessed the included trials and data entry. Primary outcomes were total mortality; total serious adverse events; total cardiovascular events; myocardial infarction, stroke, congestive heart failure and end stage renal disease. Secondary outcomes were achieved mean systolic and diastolic BP and withdrawals due to adverse effects.

Main results

No trials comparing different systolic BP targets were found. Seven trials (22,089 subjects) comparing different diastolic BP targets were included. Despite a -4/-3 mmHg greater achieved reduction in systolic/diastolic BP, p< 0.001, attempting to achieve "lower targets" instead of "standard targets" did not change total mortality (RR 0.92, 95% CI 0.86-1.15), myocardial infarction (RR 0.90, 95% CI 0.74-1.09), stroke (RR 0.99, 95% CI 0.79-1.25) , congestive heart failure (RR 0.88, 95% CI 0.59-1.32), major cardiovascular events (RR 0.94, 95% CI 0.83-1.07), or end-stage renal disease (RR 1.01, 95% CI 0.81-1.27). The net health effect of lower targets cannot be fully assessed due to lack of information regarding all total serious adverse events and withdrawals due to adverse effects in 6 of 7 trials. A sensitivity analysis in diabetic patients and in patients with chronic renal disease also did not show a reduction in any of the mortality and morbidity outcomes with lower targets as compared to standard targets.

Authors' conclusions

Treating patients to lower than standard BP targets, ≤140-160/90-100 mmHg, does not reduce mortality or morbidity. Because guidelines are recommending even lower targets for diabetes mellitus and chronic renal disease, we are currently conducting systematic reviews in those groups of patients.




治療高血壓時,醫師應設定目標血壓。臨床上一般以,140  160/90  100 毫米汞柱(mmHg)為目標。目前較新的治療準則則是設定在更低的血壓,然而這是否能進一步降低死亡率及相關併發症則是未知。


探討更嚴格的血壓控制在135/85 毫米汞柱,是否能比傳統的140 – 160/90 – 100 毫米汞柱進一步降低死亡率及相關併發症。


搜尋的資料庫包括MEDLINE (1966 – 2008), EMBASE (1980 – 2008), and CENTRAL (2008/06)裡的review article,臨床治療準則以及臨床試驗。






ˋ搜尋資料庫並沒有找到針對不同收縮壓目標做探討的研究。另有7個研究,共22,089個受試者,針對不同的舒張壓目標探討。和標準血壓控制目標的組別相比,將血壓控制在較低標準的組別,收縮壓降低至少4毫米汞柱,舒張壓降低至少3毫米汞柱,(p< 0.001),卻未能改變整體死亡率(RR 0.92, 95% CI 0.86 – 1.15),心肌梗塞(RR 0.90, 95% CI 0.74 – 1.09),中風(RR 0.99, 95% CI 0.79 – 1.25),心衰竭(RR 0.88, 95% CI 0.59 – 1.32),重大心血管事件(RR 0.94, 95% CI 0.83 – 1.07),或末期腎臟病(RR 1.01, 95% CI 0.81 – 1.27)的比例。然而在7個研究中,有6個研究缺乏關於整體不良反應及因此中輟參與研究的資訊,因此無法完整評估較低的血壓標準於整體健康之效應。針對糖尿病病人及慢性腎臟病病人之敏感性分析,也表示未能降低死亡率及相關併發症。


將病人的血壓控制在低於標準血壓140 – 160/90100 毫米汞柱,並不能降低死亡率及併發症之比例。此外,由於臨床治療準則建議將糖尿病及慢性腎臟病病人的血壓控制在較低的標準,我們目前正在進行對此一特殊族群之系統性的探討分析。



此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
















種々の収縮期BP目標値を比較している試験は見出せなかった。種々の拡張期BP目標値を比較している試験7件(参加者22,089例)を含めた。「標準目標値」ではなく「それよりも低い目標値」を達成する試みは、収縮期/拡張期BPで-4/-3mmHgを上回る低下を達成したにもかかわらず(p<0.001)、総死亡率(RR 0.92、95%CI 0.86~1.15)、心筋梗塞(RR 0.90、95%CI 0.74~1.09)、脳卒中(RR 0.99、95%CI 0.79~1.25)、うっ血性心不全(RR 0.88、95%CI 0.59~1.32)、主な心血管事象(RR 0.94、95%CI 0.83~1.07)、末期腎疾患(RR 1.01、95%CI 0.81~1.27)に変化はなかった。7試験中6試験であらゆる重篤な有害事象および有害事象による試験中止に関する情報がなかったため、標準よりも低い目標値の健康へ正味の影響を十分に評価することはできない。糖尿病患者および慢性腎疾患患者を対象とした感度分析でも、標準目標値と比較して、それよりも低い目標値による死亡率および罹病率のアウトカムの低下は見出せなかった。




監  訳: 相原 守夫,2009.11.16

実施組織: 厚生労働省委託事業によりMindsが実施した。

ご注意 : この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、Minds事務局までご連絡ください。Mindsでは最新版の日本語訳を掲載するよう努めておりますが、編集作業に伴うタイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。

Plain language summary

Aiming for blood pressure targets lower than 140/90 mmHg is not beneficial

High blood pressure (BP) is linked to an increased risk of heart attack and stroke. High BP has been defined as any number larger than 140 to 160 /90 to 100 mmHg and as a result this range of BPs has become the standard blood pressure target for physicians and patients. Over the last five years a trend toward lower targets has been recommended by hypertension experts who set treatment guidelines. This trend is based on the assumption that the use of drugs to bring the BP lower than140/90 mmHg will reduce heart attack and stroke similar to that seen in some population studies. However, this approach is not proven.

This review was performed to find and assess all trials designed to answer whether lower blood pressure targets are better than standard blood pressure targets. Data from 7 trials in over 22,000 people were analysed. Using more drugs in the lower target groups did achieve modestly lower blood pressures. However, this strategy did not prolong survival or reduce stroke, heart attack, heart failure or kidney failure. More trials are needed, but at present there is no evidence to support aiming for a blood pressure target lower than 140/90 mmHg in any hypertensive patient.

Laički sažetak

Ciljana vrijednost krvnog tlaka niža od 140/90 mmHg u liječenju hipertenzije nije preporučljiva

Visoki arterijski krvni tlak povezan je s povećanim rizikom od srčanog i moždanog udara. Visoki arterijski krvni tlak definira se kao bilo koji broj iznad 140 do 160 / 90 do 100 mmHg, zbog čega je taj raspon postao standardna ciljana vrijednost za snižavanje tlaka u liječenju hipertenzije (povišenog arterijskog krvnog tlaka). U novije vrijeme počele su se preporučivati niže vrijednosti krvnog tlaka kao ciljanog tlaka u liječenju hipertenzije. Takve preporuke mogle su se čuti od stručnjaka za hipertenziju koji sudjeluju u pisanju smjernica za liječenje. Taj trend temelji se na pretpostavci da se korištenjem lijekova koji će sniziti krvni tlak na vrijednost manju od 140/90 mmHg može smanjiti rizik od srčanog i moždanog udara. Međutim, taj pristup nije dokazan.

U ovom Cochrane sustavnom pregledu analizirana je literatura kako bi se pronašli svi klinički pokusi u kjima je ispitano jesu li niže ciljane vrijednosti krvnog tlaka bolje nego standardne ciljane vrijednosti krvnog tlaka. Analizirano je 7 studija u kojima je sudjelovalo ukupno više od 22.000 osoba. Korištenje više lijekova za postizanje niže ciljane vrijednosti krvnog tlaka zaista je postiglo umjerena smanjenja krvnog tlaka. Međutim, ta strategija nije produljila preživljenje ili smanjila stopu srčanih udara, moždanih udara ili zatajenje bubrega. Potrebno je više istraživanja na ovu temu, ali važno je naglasiti da u ovom trenutku nema dokaza koji bi podupirali smanjivanje krvnog tlaka na vrijednosti niže od 140/90 mmHg u bilo kojeg pacijenta s hipertenzijom.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Livia Puljak
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: