Article Text

Download PDFPDF
Primary care
Blood pressure-lowering treatment lowers mortality and cardiovascular disease risk, but whether effects differ at an arbitrary threshold of 140 mm Hg systolic blood pressure requires further research
  1. Dexter Canoy,
  2. Kazem Rahimi
  1. The George Institute for Global Health, University of Oxford, Oxford, UK
  1. Correspondence to Dr Dexter Canoy, The George Institute for Global Health, University of Oxford, Oxford OX1 3QX, UK; dexter.canoy{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Commentary on: Brunström M, Carlberg B. Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: a systematic review and meta-analysis. JAMA Intern Med 2018;178:28–36.


Favourable vascular health outcomes associated with blood pressure (BP)-lowering treatment are well-established. Using evidence from randomised controlled trials (RCTs), clinical guidelines support initiating treatment in patients with elevated BP usually set at systolic/diastolic BP ≥140/≥85 mm Hg. Over the years, increasing evidence suggests beneficial effects of BP-lowering treatment at baseline BP below these thresholds.1–3 However, in this current meta-analysis, methods used in earlier studies1 2 were questioned and aimed to re-examine differential effects of BP-lowering treatment on mortality and cardiovascular disease (CVD) by baseline systolic BP (SBP).4


This meta-analysis included BP-lowering treatment trials (vs placebo or each other with different BP targets) on all-cause mortality, CVD mortality, major cardiovascular events (MACE), coronary heart disease (CHD), stroke, heart failure and end-stage renal …

View Full Text


  • Contributors DC wrote the original draft of the commentary. KR contributed to subsequent versions of the drafted commentary. Both DC and KR approve the final version of this commentary.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.