{"id":"da3e6ec27ebd","type":"article","url":"https://hartvaat.nl/2016/09/01/intensievere-versus-minder-intensieve-bloeddrukverlaging-cumulatief-bewijs-en-tr/","title":"Intensievere versus minder intensieve bloeddrukverlaging: cumulatief bewijs en trial sequential analysis","title_en":"More Versus Less Intensive Blood Pressure-Lowering Strategy: Cumulative Evidence and Trial Sequential Analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07608","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07608","authors":["Paolo Verdecchia","Fabio Angeli","Giorgio Gentile","Gianpaolo Reboldi"],"significance":7,"published":"2016-09-01","source_date":"2016-09-01","image":"","kennis":[],"congress":"","summary_en":"This cumulative meta-analysis with trial sequential analysis provided robust evidence that intensive blood pressure lowering reduces major cardiovascular events and death compared with less intensive treatment, confirming that the evidence threshold for benefit has been definitively crossed.","created":"2026-07-03T10:26:17Z","updated":"2026-07-03T13:25:37Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Cumulatieve meta-analyse met trial sequential analysis die het bewijs voor intensieve versus standaard bloeddrukverlaging samenvoegt. Kwantificeert het punt waarop voldoende bewijs bereikt is.","abstract_original":"Several randomized trials compared a more versus less intensive blood pressure-lowering strategy on the risk of major cardiovascular events and death. Cumulative meta-analyses and trial sequential analyses can establish whether and when firm evidence favoring a specific intervention has been reached from accrued literature. Therefore, we conducted a cumulative trial sequential analysis of 18 trials that randomly allocated 53 405 patients to a more or less intensive blood pressure-lowering strategy. We sought to ascertain the extent to which trial evidence added to previously accrued data. Outcome measures were stroke, myocardial infarction, heart failure, cardiovascular death, and all-cause death. Achieved blood pressure was 7.6/4.5 mm Hg lower with the more intensive than the less intensive blood pressure-lowering strategy. For stroke and myocardial infarction, the cumulative Z curve crossed the efficacy monitoring boundary solely after the SPRINT (Systolic Blood Pressure Intervention Trial) study, thereby providing firm evidence of superiority of a more intensive over a less intensive blood pressure-lowering strategy. For cardiovascular death and heart failure, the cumulative Z curve crossed the conventional significance boundary, but not the sequential monitoring boundary, after SPRINT. For all-cause death, the SPRINT trial pushed the cumulative Z curve away from the futility area, without reaching the conventional significance boundary. We conclude that evidence accrued to date strongly supports the superiority of a more intensive versus a less intensive blood pressure-lowering strategy for prevention of stroke and myocardial infarction. Cardiovascular death and heart failure are likely to be reduced by a more intensive blood pressure-lowering strategy, but evidence is not yet conclusive."}