For many decades, the optimum blood pressure treatment target to prevent cardiovascular disease has been debated. Until 2013, most guidelines suggested that the general population with hypertension should be treated to achieve a blood pressure goal of lower than 140/90 mm Hg, but that the goal for some high-risk groups, such as patients with diabetes and chronic kidney disease, should be a blood pressure of lower than 130/80 mm Hg. In 2013, most guidelines relaxed the recommendations for high-risk patients, based on a lack of evidence, which was brought to attention after the disappointing results of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. In The Lancet, Xinfang Xie and colleagues4 present the results of a systematic review and meta-analysis of randomised controlled trials comparing intensive versus less intensive blood pressure-lowering treatment strategies. They used evidence from 19 trials with 44989 participants and 2496 major cardiovascular events to show that intensive blood pressure lowering is associated with reduced risk of the composite endpoint major cardiovascular events (relative risk reduction 14% [95% Cl 4-22]), as well as stroke (22% [10-32]) and myocardial infarction (13% [0-24]). The mean blood pressure achieved in the intensive treatment group was 133/76 mm Hg, compared with 140/81 mm Hg in the less intensive treatment group. Xie and colleagues conclude that "there are additional benefits from more intensive blood pressure lowering, including for those with systolic blood pressure below 140 mm Hg". However, three issues need to be discussed further. First, the most crucial decision in the design of a systematic review is which studies to include. In Xie and colleagues' systematic review,4 the authors included trials comparing different blood pressure targets. It is the most comprehensive compilation of such trials so far, but the results of the review still do not represent all the available evidence for blood pressure lowering.
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机译：几十年来，关于预防心血管疾病的最佳血压治疗目标一直存在争议。直到2013年，大多数指南都建议应该对一般高血压人群进行治疗，使其血压目标低于140/90 mm Hg，但对于某些高危人群，例如糖尿病和慢性肾脏病患者，则应达到该目标。 ，血压应低于130/80毫米汞柱。 2013年，由于缺乏证据，大多数指南放宽了对高危患者的建议，在《控制心血管风险的行动》（ACCORD）试验令人失望的结果后引起了关注。在《柳叶刀》杂志上，谢新芳及其同事4提出了对重度降压治疗策略与不重度降压治疗策略进行比较的随机对照试验的系统评价和荟萃分析的结果。他们使用了来自44989名参与者和2496例重大心血管事件的19项试验的证据，表明降低血压与降低复合终点主要心血管事件的风险相关（相对风险降低14％[95％Cl 4-22]），以及中风（22％[10-32]）和心肌梗塞（13％[0-24]）。强化治疗组的平均血压为133/76 mm Hg，而强化程度较低的组为140/81 mm Hg。 Xie及其同事得出结论，“进一步降低血压还有其他好处，包括那些收缩压低于140毫米汞柱的患者。”但是，三个问题需要进一步讨论。首先，系统评价设计中最关键的决定是要纳入哪些研究。在谢和同事的系统评价中，4作者包括比较不同血压目标的试验。这是迄今为止此类试验的最全面的汇编，但审查结果仍不能代表所有可用于降低血压的证据。
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