Association Between Follow-Up Mean Blood Pressure and Blood Pressure Control: A Meta-Regression Analysis of 101 Randomized Trials

BACKGROUND: The relationship between mean blood pressure (BP) and BP control remains uncertain, particularly the mean BP required to achieve BP control (<140/90 mm Hg) in most patients. This review assesses the association between mean BP and BP control using data from randomized clinical trials (RCTs). METHODS: Electronic literature databases were searched to identify individual RCTs (iRCTs) and cluster RCTs (cRCTs) that randomized adults to BP-lowering interventions and reported both mean BP at final follow-up visit (mean BP) and the proportion of participants achieving BP control at the final follow-up visit (BP control). RESULTS: A linear regression model was used to evaluate the association between mean BP and BP control. A total of 101 RCTs (65 iRCTs [57 201 participants] and 36 cRCTs [28 154 participants]) were included. Overall, mean systolic BP (SBP) of 120, 125, 130, and 135 mm Hg corresponded to BP control in 85%, 75%, 65% and 55% of the participants in iRCTs and 87%, 77%, 67%, 57% in cRCTs. Each 1 mm Hg reduction in mean SBP was associated with approximately a 2% increase in BP control (Pseudo- R 2 =78% for iRCTs; 76% for cRCTs). This association was consistent across BP-lowering drug classes, baseline SBP categories, and pretrial treatment status in iRCTs, and across country income levels and baseline SBP categories in cRCTs. A similar association was seen for DBP. CONCLUSIONS: An SBP below 125 mm Hg was associated with achieving BP control in ≈80% of patients. These findings can inform guideline recommendations, guide clinical management and shape hypertension control programs.