Physicians' Academy for Cardiovascular Education

Lower achieved SBP and DBP associated with more CV events

Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials

Böhm M, Schumacher H, Teo KK, et al. - Lancet. 2017; published online ahead of print


Guidelines recommend a target blood pressure (BP) <140/90 mmHg for the reduction of cardiovascular (CV) events, although the CV risk is also higher at low systolic blood pressure (SBP), resulting in a J-curve [1-4]. The risk reduction associated with high baseline SBP and low achieved SBP might be different for individual endpoints. In the ONTARGET and the TRANSCEND trials, in which 31 546 patients at high CV risk received ramipril, telmisartan or their combination, there were no differences in CV disease outcomes after 56 months of follow-up [5,6].

In this secondary analysis of the ONTARGET and TRANSCEND trials, the associations between mean BP achieved on treatment, pre-randomisation baseline BP or time-updated BP (last on treatment value before an event) and the composite outcome of CV death, myocardial infarction (MI), stroke and hospital admission for heart failure (HF), as well as all-cause death were evaluated. Given that there were no differences in outcomes between ONTARGET and TRANSCEND randomized groups, they were combined for this analysis

Main results


In high-risk CV patients, lowering SBP to less than 130 mmHg or DBP to less than 75 mmHg, is associated with increased rates for CV death, MI and HF, but not stroke. These findings suggest that in some patients at low SBP on treatment, blood pressure medication might have to be reduced to avoid adverse outcomes, since treat to target does not mean treat under target.


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Find this article online at The Lancet