Protocol · graded by use, four uses
Blood pressure lowering: treating high blood pressure and intensive targets
Graded on: major cardiovascular events (stroke, heart attack, heart failure, cardiovascular death) and death from any cause; dementia and mild cognitive impairment on a separate row.
At a glance
This page is about bringing high blood pressure down. Hundreds of thousands of people have been in trials, most taking blood pressure pills. People whose pressure came down had fewer strokes, heart attacks and cases of heart failure, and fewer died. Bringing the top number below 120 or 130 prevented more of these events than stopping at 140 or 150. That also caused more fainting, very low pressure, kidney problems and changes in blood salts. One large trial in people over 80 found fewer deaths. Trials also found a little less memory loss and dementia, though the results were not all the same.
- What was measured
- Heart attacks, strokes, heart failure and deaths over several years.
- How big
- Aiming lower cut serious heart events from 2.19% to 1.65% a year, about 5 fewer per 1,000 people each year.Read from the summary of PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 26551272.
- Who it applies to
- Adults with high blood pressure and raised heart risk. The evidence is weaker at 80 and over.
- Safety
- Lower targets brought more fainting, low blood pressure, kidney injury and salt imbalance in the blood.
- Compared with
- Dummy pills, less treatment, or a higher blood pressure target.
- Certainty
- Grade A, resting on: Individual-participant and trial-level meta-analyses A study that pools the numbers from several trials into one combined estimate. of randomized trials, and large randomized trials of intensive against standard targets.
- What would change this grade
- Could move down to B if this trial found no benefit: Pooled analysis or large trial finding that lowering blood pressure no longer reduces heart events on modern background treatment. Who: Adults with high blood pressure. Measured: Major heart and circulation events and death. Length: At least 3 years.
- Cost
- No price recorded yet.
- Sources
- 24 studies cited on this record, listed under Sources.
The A is shared by two of the four uses graded on this record, each on its own evidence. The other two carry their own letters.
This record carries a separate letter for each thing it has been measured on. The headline grade is the best of them, and it does not transfer to the others.
Blood Pressure Lowering Treatment Trialists' Collaboration (2021; PMID 33933205), individual data from 48 trials and 344,716 people: hazard ratio How often an event happened in the treated group compared with the control group over the same period. A ratio of 0.80 means 20 percent fewer events. per 5 mm Hg lower systolic pressure 0.91 (95% CI 0.89 to 0.94) without previous cardiovascular disease and 0.89 (0.86 to 0.92) with it; major events 25.9 against 31.9 per 1,000 person-years without previous disease and 36.0 against 39.7 with it. Ettehad et al. (2016; PMID 26724178), 123 trials and 613,815 people: per 10 mm Hg, major cardiovascular events relative risk The risk in one group expressed as a share of the risk in another. It can make a small absolute difference look large. 0.80, stroke 0.73, heart failure 0.72 and all-cause death 0.87 (13% lower); renal failure did not fall significantly. SHEP (PMID 2046107) and Syst-Eur (PMID 9297994), independent placebo-controlled trials, each found fewer strokes and cardiovascular events. Lonn et al., HOPE-3 (2016; PMID 27041480) treated intermediate-risk people with average pressure 138.1/81.9 mm Hg and found no overall difference (hazard ratio 0.93), with benefit in the upper third of systolic pressure. Wang et al. (Cochrane, 2025; PMID 40990196), five trials and 9,124 people with untreated mild hypertension (140 to 159 systolic or 90 to 99 diastolic) and no cardiovascular disease: all-cause death RR 0.85 (95% CI 0.64 to 1.14) and total cardiovascular events RR 0.93 (0.69 to 1.24), low certainty; stroke RR 0.41 (0.20 to 0.84). Replicated The same finding reproduced by a separate research group. A result seen once can be chance or bias; a replicated one is harder to explain away. hard outcomes by independent groups: A.
Wright et al., SPRINT (2015; PMID 26551272): primary composite 1.65% against 2.19% per year (hazard ratio 0.75, 95% CI 0.64 to 0.89), all-cause death hazard ratio 0.73; final report (2021; PMID 34010531): 1.77% against 2.40% per year (hazard ratio 0.73) and death 1.06% against 1.41% per year (hazard ratio 0.75). Zhang et al., STEP (2021; PMID 34491661): 3.5% against 4.6% (hazard ratio 0.74). Liu et al., ESPRIT (2024; PMID 38945140): 9.7% against 11.1% (hazard ratio 0.88, 95% CI 0.78 to 0.99). Bi et al., BPROAD (2025; PMID 39555827), type 2 diabetes: 1.65 against 2.09 events per 100 person-years (hazard ratio 0.79). Cushman et al., ACCORD (2010; PMID 20228401), type 2 diabetes: primary composite hazard ratio 0.88 (95% CI 0.73 to 1.06), not significant; stroke hazard ratio 0.59. He et al., CRHCP (2023; PMID 36871573), 33,995 adults in 326 villages in rural China, target under 130/80 mm Hg against usual care: 1.62% against 2.40% per year (hazard ratio 0.67), all-cause death hazard ratio 0.85. Guo et al. (2025; PMID 40902616) pooled six trials and 80,220 participants: hazard ratio 0.76, number needed to treat 58, number needed to harm 55 for adverse events of interest. Replicated hard outcomes by independent groups in the United States and China: A. All-cause death fell in SPRINT; it is not graded here as a separate replicated finding.
Beckett et al., HYVET (2008; PMID 18378519), 3,845 adults aged 80 and over: death from any cause 21% lower (95% CI 4 to 35), heart failure 64% lower, fatal or nonfatal stroke 30% lower (95% CI -1 to 51, P=0.06), and fewer serious adverse events (358 against 448). The BPLTTC age-stratified analysis (2021; PMID 34461040) found a hazard ratio per 5 mm Hg of 0.91 (0.87 to 0.96) at ages 75 to 84 and 0.99 (0.87 to 1.12) at 85 and over, where only 4,788 participants were available. One dedicated trial with a meaningful effect on death, not repeated in a second trial of this age group, and not shown in the pooled 85-and-over stratum. A single positive trial nobody has independently repeated is C under the written definitions, however large; the pooled 75 to 84 stratum is a different age group.
Williamson et al., SPRINT MIND (2019; PMID 30688979): probable dementia 7.2 against 8.6 per 1,000 person-years, hazard ratio 0.83 (95% CI 0.67 to 1.04), not significant on the primary outcome; mild cognitive impairment hazard ratio 0.81 (0.69 to 0.95). Extended follow-up, Reboussin et al. (2025; PMID 39819096): probable dementia hazard ratio 0.86 (0.72 to 1.02); mild cognitive impairment or dementia 0.89 (0.79 to 0.99). He et al., CRHCP (2025; PMID 40258956), 33,995 adults in 326 villages in rural China: all-cause dementia risk ratio 0.85 (0.76 to 0.95). Peters et al., HYVET-COG (2008; PMID 18614402): hazard ratio 0.86 (0.67 to 1.09), not significant. Forette et al., Syst-Eur extended follow-up (2002; PMID 12374512): dementia 3.3 against 7.4 per 1,000 patient-years. Pooled: Hughes et al. (2020; PMID 32427305), 12 trials, odds ratio 0.93 (0.88 to 0.98), absolute risk The actual chance of an event in a group. A fall from 2 percent to 1 percent is a 1-point absolute reduction, even though it is a 50 percent relative one. reduction 0.39%; Peters et al. (2022; PMID 36282295), five placebo-controlled trials, odds ratio 0.87 (0.75 to 0.99). One large well-designed trial with a meaningful effect (CRHCP), supported by pooled analyses, while the two largest double-blind Neither the participants nor the people assessing them know who received the real treatment until the trial ends. or adjudicated trials missed their dementia endpoints The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score.: B.
Lowering blood pressure in people with high blood pressure, against placebo or less treatment, on major cardiovascular events and death (A). An intensive systolic target under 120 to 130 mm Hg against a standard target, on major cardiovascular events (A). Treatment in adults aged 80 and over (C). Dementia or mild cognitive impairment (B).
Why this letter
Why this gradeThe reasoning, and what the grade does not cover.
Grade A on major cardiovascular events and death. Lowering blood pressure in people with high blood pressure reduced major cardiovascular events in individual data from 48 trials (BPLTTC 2021, PMID 33933205) and in 123 trials, with 13 percent fewer deaths from any cause per 10 mm Hg (Ettehad 2016, PMID 26724178); independent placebo-controlled trials in the United States (SHEP, PMID 2046107) and Europe (Syst-Eur, PMID 9297994) each found fewer strokes and cardiovascular events. Intensive systolic targets reduced major cardiovascular events in SPRINT (PMID 26551272), STEP (PMID 34491661), ESPRIT (PMID 38945140) and BPROAD (PMID 39555827), run by independent groups in the United States and China, and in the CRHCP village trial (PMID 36871573).
WHY THE OTHER TWO USES SIT LOWERin adults 80 and over the benefit rests on one dedicated trial (HYVET, PMID 18378519), not repeated, and the pooled 85-and-over stratum showed no clear effect (PMID 34461040), so that use is C; for dementia, B because CRHCP (PMID 40258956) and pooled analyses (PMIDs 32427305, 36282295) found benefit, but SPRINT MIND (PMID 30688979) and HYVET-COG (PMID 18614402) missed their dementia endpoints.
WHAT THIS GRADE DOES NOT COVERpeople with untreated mild hypertension and no cardiovascular disease, where a Cochrane review of five trials found no clear fall in deaths or total cardiovascular events, low certainty, though strokes fell (PMID 40990196); intermediate-risk people with average pressure near 138/82 mm Hg, where HOPE-3 found no overall benefit (PMID 27041480); intensive targets in type 2 diabetes as settled, since ACCORD (PMID 20228401) missed its primary endpoint The one outcome a trial names in advance as its main test. Results on other outcomes carry less weight. and BPROAD (PMID 39555827) met it; any one drug, diet, supplement or device, which carries its own record; and blood pressure readings as an outcome, which the DASH, sodium and monitor records grade at B.
Shared endpoint: Major cardiovascular events with an intensive against a standard systolic target
- SPRINT Research Group, 102 sites in the United States and Puerto Rico: Primary composite 1.65% against 2.19% per year, hazard ratio 0.75; all-cause death hazard ratio 0.73; 9,361 adults without diabetes. PMID 26551272 · Funding: National Institutes of Health
- STEP investigators, China (Zhang): Primary composite 3.5% against 4.6%, hazard ratio 0.74; 8,511 adults aged 60 to 80 with hypertension. PMID 34491661 · Funding: Chinese Academy of Medical Sciences and others
What the replication does not cover: ESPRIT (PMID 38945140) and BPROAD (PMID 39555827), both government-funded in China, repeat the benefit; ACCORD (PMID 20228401), in type 2 diabetes, did not reach significance on its primary composite (hazard ratio 0.88, 95% CI 0.73 to 1.06) though stroke fell. All trials were open to treatment assignment, and intensive arms had more hypotension, syncope, kidney injury and electrolyte problems.
Shared endpoint: Stroke and major cardiovascular events with drug treatment against placebo in older adults with isolated systolic hypertension
- SHEP Cooperative Research Group, United States: Total stroke 5.2 against 8.2 per 100 over 5 years, relative risk 0.64; major cardiovascular events relative risk 0.68; 4,736 adults aged 60 and over. PMID 2046107 · Funding: not stated in the indexed record
- Syst-Eur, European Working Party on High Blood Pressure in the Elderly (Staessen): Stroke 13.7 against 7.9 per 1,000 patient-years (42% reduction); all cardiovascular endpoints down 31%; 4,695 adults over 60. PMID 9297994 · Funding: not stated in the indexed record
What the replication does not cover: Both trials used drugs against placebo in older adults with high systolic pressure; neither found a significant fall in all-cause death on its own (relative risk 0.87 in SHEP, 14% lower and not significant in Syst-Eur). The fall in death from any cause comes from pooling 123 trials (PMID 26724178).
Shared endpoint: Major cardiovascular events with an intensive against a standard systolic target
- SPRINT Research Group, 102 sites in the United States and Puerto Rico: Primary composite 1.65% against 2.19% per year, hazard ratio 0.75; all-cause death hazard ratio 0.73; 9,361 adults without diabetes. PMID 26551272 · Funding: National Institutes of Health
- STEP investigators, China (Zhang): Primary composite 3.5% against 4.6%, hazard ratio 0.74; 8,511 adults aged 60 to 80 with hypertension. PMID 34491661 · Funding: Chinese Academy of Medical Sciences and others
What the replication does not cover: ESPRIT (PMID 38945140) and BPROAD (PMID 39555827), both government-funded in China, repeat the benefit; ACCORD (PMID 20228401), in type 2 diabetes, did not reach significance on its primary composite (hazard ratio 0.88, 95% CI 0.73 to 1.06) though stroke fell. All trials were open to treatment assignment, and intensive arms had more hypotension, syncope, kidney injury and electrolyte problems.
A grade describes the human evidence for a named use. It is not advice, and it is not a judgment on any individual prescription. How the letters are decided →
Trials report an average. This box says whether any trial on this record looked at who the result applies to, and what it found.
For this record's Grade A · Subgroup tested, effect differedEttehad et al. (Lancet, 2016; PMID 26724178) found smaller but significant risk reductions in people with diabetes and chronic kidney disease. The BPLTTC age analysis (Lancet, 2021; PMID 34461040) found similar relative benefit from 55 to 84 and no clear effect at 85 and over (hazard ratio 0.99), and Lonn et al., HOPE-3 (2016; PMID 27041480) found benefit only in the upper third of systolic pressure in intermediate-risk people. In untreated mild hypertension without cardiovascular disease, a Cochrane review found no clear fall in deaths or total cardiovascular events (Wang et al., 2025; PMID 40990196). A subgroup result shows who the effect appeared in within these trials. It does not change the letter.
ClinicalTrials.gov, the public registry run by the U.S. National Library of Medicine, lists studies that are recruiting volunteers. The link below searches it for Antihypertensive among studies recruiting now. EBL has no relationship with any listed study and receives no payment for this link.
Search recruiting studies of Antihypertensive on ClinicalTrials.gov
Evidence notes: meta-analysis of randomized trials, randomized trial
Endpoint graded: Major cardiovascular events (stroke, heart attack, heart failure, cardiovascular death) and death from any cause; dementia and mild cognitive impairment on a separate row (hard)
Last reviewed: October 2026
Dose, form and timing
Measured outcome: adjudicated major cardiovascular events and deaths during trial follow-up (PMIDs 33933205, 26551272, 34491661). Dementia and mild cognitive impairment were adjudicated diagnoses (PMIDs 30688979, 40258956). Blood pressure readings are the means, not the graded outcome.
As studiedDose, form, population and duration for every use.
A grade describes the intervention that was tested. Where the product on the shelf differs from it, this says so.
Safety
Intensive targets: SPRINT found more serious adverse events of hypotension, syncope, electrolyte abnormalities and acute kidney injury or failure, but not injurious falls (PMID 26551272), confirmed in the final report (PMID 34010531). ESPRIT found serious syncope in 0.4% against 0.1% (hazard ratio 3.00), with no significant difference in hypotension, electrolyte abnormality, injurious fall or acute kidney injury (PMID 38945140). BPROAD found more symptomatic hypotension and hyperkalemia (PMID 39555827). STEP found more hypotension (PMID 34491661), and CRHCP 1.75% against 0.89% (PMID 36871573). ACCORD found serious adverse events attributed to treatment in 3.3% against 1.3% (PMID 20228401). Pooled across six intensive-target trials, the number needed to treat to prevent one cardiovascular event was 58 and the number needed to harm for one extra adverse event of interest, such as hypotension or syncope, was 55 (PMID 40902616). Any drug treatment against placebo or less treatment, 58 trials: higher acute kidney injury (risk ratio 1.18), hyperkalemia (1.89), hypotension (1.97) and syncope (1.28), with no association with falls (Albasri et al., 2021; PMID 33568342). In mild hypertension, one trial found withdrawals for adverse effects about 4.8 times as common on treatment (PMID 40990196).
Cautions documented in human studies. Each caution on this record, sorted by what it rests on.
- Intensive targets in SPRINT: more serious hypotension, syncope, electrolyte abnormalities and acute kidney injury, but not injurious falls (PMID 26551272 PMID 34010531)
- Other intensive-target trials: more serious syncope, symptomatic hypotension, hyperkalemia and treatment-attributed serious adverse events (PMID 38945140 PMID 39555827 PMID 34491661 PMID 36871573 PMID 20228401)
- Trade-off: across six intensive-target trials, the number needed to harm (55) was close to the number needed to treat (58) (PMID 40902616)
- Any drug treatment, 58 trials: more acute kidney injury, hyperkalemia, hypotension and syncope, with no association with falls (PMID 33568342)
- Mild hypertension: withdrawals for adverse effects were about 4.8 times as common on treatment in one trial (PMID 40990196)
None recorded.
None recorded.
None recorded.
Does not apply: human harm data are listed above.
Grade history
How this letter has changedLatest: No. 393 · October 2026 · First graded.
Blood pressure lowering: treating high blood pressure and intensive targets now has its own record, graded use by use after a full PubMed search in October 2026: Lowering blood pressure in people with high blood pressure, against placebo or less treatment: major cardiovascular events and death (A); Intensive systolic target (under 120 to 130 mm Hg) against a standard target: major cardiovascular events (A); Treating high blood pressure in adults aged 80 and over (C); Dementia or mild cognitive impairment (B). Lowering blood pressure in people with high blood pressure, against placebo or less treatment, on major cardiovascular events and death (A). An intensive systolic target under 120 to 130 mm Hg against a standard target, on major cardiovascular events (A). Treatment in adults aged 80 and over (C). Dementia or mild cognitive impairment (B). Applied the written grade definitions under the editor's standing instruction of October 2026 (Arnold Sandlow, D.C.).PMID 33933205 PMID 26724178 PMID 34461040 PMID 2046107 PMID 9297994 PMID 27041480 PMID 40990196 PMID 36871573 PMID 33568342 PMID 26551272 PMID 34010531 PMID 20228401
Every change to a letter on this site is dated and published. The full evidence log →
Sources
- Citations
- Every paper cited on this page is matched to its PubMed record on every build.
- Retractions
- None of these papers is retracted or under a journal expression of concern. PubMed is checked again on every build.
- Read against the papers
- October 2026. By a language model (AI-assisted reading), not yet reviewed by a clinician.
- Outside review
- Not yet done. No reviewer outside EBL has checked this record.
What each of these checks can and cannot show: evidence integrity.
The evidence, in full24 papers, each linked to its PubMed record.
Blood Pressure Lowering Treatment Trialists' Collaboration (Lancet, 2021; PMID 33933205): individual participant data from 48 randomized trials, 344,716 participants, median follow-up 4.15 years; hazard ratio for a major cardiovascular event per 5 mm Hg lower systolic pressure 0.91 (95% CI 0.89 to 0.94) without and 0.89 (0.86 to 0.92) with previous cardiovascular disease; events per 1,000 person-years 25.9 against 31.9 and 36.0 against 39.7. Ettehad et al. (Lancet, 2016; PMID 26724178): 123 trials, 613,815 participants; every 10 mm Hg lower systolic pressure reduced major cardiovascular events (relative risk 0.80), coronary heart disease (0.83), stroke (0.73), heart failure (0.72) and all-cause death (0.87); renal failure 0.95, not significant. Blood Pressure Lowering Treatment Trialists' Collaboration (Lancet, 2021; PMID 34461040): 358,707 participants of 51 trials stratified by age; hazard ratio per 5 mm Hg 0.82 under 55, 0.91 at 55 to 64, 65 to 74 and 75 to 84, and 0.99 (0.87 to 1.12) at 85 and over. SHEP Cooperative Research Group (JAMA, 1991; PMID 2046107): 4,736 adults aged 60 and over with isolated systolic hypertension; total stroke 5.2 against 8.2 per 100 over 5 years (relative risk 0.64), major cardiovascular events relative risk 0.68, 5-year absolute benefit 55 major events per 1,000; all-cause death relative risk 0.87. Staessen et al., Syst-Eur (Lancet, 1997; PMID 9297994): 4,695 adults over 60; stroke 13.7 against 7.9 per 1,000 patient-years; all cardiovascular endpoints down 31%; all-cause death not significantly changed. Lonn et al., HOPE-3 (New England Journal of Medicine, 2016; PMID 27041480): 12,705 intermediate-risk adults without cardiovascular disease, candesartan plus hydrochlorothiazide against placebo, pressure 6.0/3.0 mm Hg lower; first coprimary outcome 4.1% against 4.4% (hazard ratio 0.93, not significant), benefit in the upper third of systolic pressure. Wright et al., SPRINT (New England Journal of Medicine, 2015; PMID 26551272): 9,361 adults at increased cardiovascular risk without diabetes, systolic target under 120 against under 140 mm Hg; primary composite 1.65% against 2.19% per year (hazard ratio 0.75), all-cause death hazard ratio 0.73. Lewis et al., SPRINT final report (New England Journal of Medicine, 2021; PMID 34010531): primary composite 1.77% against 2.40% per year (hazard ratio 0.73), all-cause death 1.06% against 1.41% per year (hazard ratio 0.75). Cushman et al., ACCORD BP (New England Journal of Medicine, 2010; PMID 20228401): 4,733 adults with type 2 diabetes, same targets; primary composite 1.87% against 2.09% per year (hazard ratio 0.88, 95% CI 0.73 to 1.06, not significant); stroke 0.32% against 0.53% per year (hazard ratio 0.59); serious adverse events from treatment 3.3% against 1.3%. Zhang et al., STEP (New England Journal of Medicine, 2021; PMID 34491661): 8,511 Chinese adults aged 60 to 80, systolic target 110 to under 130 against 130 to under 150 mm Hg; primary composite 3.5% against 4.6% (hazard ratio 0.74). Liu et al., ESPRIT (Lancet, 2024; PMID 38945140): 11,255 high-risk adults in China, under 120 against under 140 mm Hg; primary outcome 9.7% against 11.1% (hazard ratio 0.88), serious syncope 0.4% against 0.1%. Bi et al., BPROAD (New England Journal of Medicine, 2025; PMID 39555827): 12,821 adults with type 2 diabetes in China, under 120 against under 140 mm Hg; 1.65 against 2.09 events per 100 person-years (hazard ratio 0.79). He et al., CRHCP (Lancet, 2023; PMID 36871573): 33,995 adults aged 40 and over with hypertension in 326 rural Chinese villages, cluster randomized, target under 130/80 mm Hg; primary composite 1.62% against 2.40% per year (hazard ratio 0.67), all-cause death hazard ratio 0.85, hypotension 1.75% against 0.89%. Wang et al. (Cochrane Database of Systematic Reviews A review that searches for every study on a question using a method set in advance, then assesses them together., 2025; PMID 40990196): five trials, 9,124 people with untreated mild hypertension and no cardiovascular disease; all-cause death RR 0.85 (0.64 to 1.14), total cardiovascular events RR 0.93 (0.69 to 1.24), stroke RR 0.41 (0.20 to 0.84), low certainty. Albasri et al. (BMJ, 2021; PMID 33568342): 58 trials, 280,638 participants; treatment raised acute kidney injury (1.18), hyperkalemia (1.89), hypotension (1.97) and syncope (1.28), with no association with falls (1.05). Guo et al. (Lancet, 2025; PMID 40902616): pooled individual data from six intensive-target trials, 80,220 participants; hazard ratio 0.76, number needed to treat 58 and number needed to harm 55. Beckett et al., HYVET (New England Journal of Medicine, 2008; PMID 18378519): 3,845 adults aged 80 and over; death from any cause 21% lower, heart failure 64% lower. Williamson et al., SPRINT MIND (JAMA, 2019; PMID 30688979): probable dementia hazard ratio 0.83 (0.67 to 1.04); mild cognitive impairment 0.81 (0.69 to 0.95). Reboussin et al. (Neurology, 2025; PMID 39819096): extended follow-up, probable dementia 0.86 (0.72 to 1.02). He et al., CRHCP (Nature Medicine, 2025; PMID 40258956): 33,995 adults in rural China, cluster randomized by village; all-cause dementia risk ratio 0.85 (0.76 to 0.95). Peters et al., HYVET-COG (Lancet Neurology, 2008; PMID 18614402): dementia hazard ratio 0.86 (0.67 to 1.09). Forette et al., Syst-Eur (Archives of Internal Medicine, 2002; PMID 12374512): dementia 3.3 against 7.4 per 1,000 patient-years. Hughes et al. (JAMA, 2020; PMID 32427305): 12 trials, odds ratio 0.93 for dementia or cognitive impairment. Peters et al. (European Heart Journal, 2022; PMID 36282295): five placebo-controlled trials, odds ratio 0.87.
How EBL searched for the trials (1 search)
The search that was run, what it returned, and what was left out and why, so the absence of evidence can be checked as well as its presence.
("blood pressure lowering"[tiab] OR antihypertensive[tiab] OR "intensive blood pressure"[tiab]) AND (mortality[tiab] OR "cardiovascular events"[tiab] OR stroke[tiab]) AND (meta-analysis[pt] OR randomized controlled trial[pt])PubMed watch: does a new study change the grade? (1 new, all reviewed)
Since the search behind this grade was run in October 2026, PubMed has added 1 paper that matches. Each one is listed with the answer to one question.
Last run October 2026. A letter on EBL moves only after a logged review. A new paper never moves a letter by arriving: it is read, the answer is written here, and any change to the letter is published in the evidence log.
- PMID 42961261 Ernesto et al. (Arq Bras Cardiol, 2026)Network meta-analysis of 27 randomized trials · Related, not the graded claimDoes this study change the grade? No, the letter stands. It compares one angiotensin receptor blocker with another on heart events and death. The A rests on lowering blood pressure itself, from individual data on hundreds of thousands of people; a comparison between drugs of one class does not change that. Reviewed October 2026.
Disclosure
Educational use only · Not medical advice · EBL grades published human evidence and does not recommend treatment. Stopping a prescription is a decision for your physician.
Evidence Based Longevity, Inc. is owner-operated and edited by Arnold Sandlow, D.C., a California-licensed chiropractor. Evidence Based Longevity publishes in English only · Machine translations are not produced or reviewed by EBL for accuracy
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These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
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