Computed from this object's own state — a structural condition is unmet. This is not a fixed disclaimer: the conditions below are each testable, and a build in which they are met renders READY.
Do intensive systolic blood-pressure targets reduce major cardiovascular events? Six landmark trials ask this and register six different composites to answer it.
In this section: Registration and administrative information (PROSPERO field set) · What this object claims to contain
| Review title | Intensive versus standard blood-pressure targets |
|---|---|
| Review question (PICO) | Do intensive systolic blood-pressure targets reduce major cardiovascular events? Six landmark trials ask this and register six different composites to answer it. |
| Population | Adults with hypertension at high CV risk |
| Intervention | Intensive BP target (e.g., SBP <120 mmHg) |
| Comparator | Standard BP target (e.g., SBP <140 mmHg) |
| Background / rationale | Not recorded — this object holds no background field, and an introduction generated without one would be argument that no source in this review supports |
| Eligibility criteria | not recorded on the page this object was built from |
| Information sources | 0 source layers, listed on the Extraction tab |
| Search strategy | The executed strings, datetimes, filters and hit counts are on the Search tab |
| Study selection process | Not recorded — no screening record was recoverable from the page this object was extracted from, so who screened and how cannot be stated |
| Number of screeners | Not recorded — this object records no screener count |
| Data extraction items | Extracted per trial on this object: registry id; primary publication; arms; per-arm counts and the published effect. Fields not listed here were not extracted. |
| Outcomes and prioritisation | Major cardiovascular events, as each of six trials separately defines them |
| Risk of bias method | Not recorded — no per-domain RoB-2 assessment exists yet |
| Synthesis methods | Not recorded — no outcome on this object carries a pooled estimate, so no synthesis method was applied |
| Subgroup analyses | Not recorded — this object records no subgroup-analysis field at all, so whether any were prespecified is UNKNOWN -- which is not the same as none having been |
| Meta-bias assessment | Not recorded — no funnel, Egger or Peters value is held on this object, so no meta-bias assessment is claimed |
| Certainty assessment | Not recorded — no GRADE record was recoverable from the page this object was extracted from |
| Funding | Not recorded — no funding statement is recorded for this review |
| Competing interests | Not recorded — no declaration is recorded |
| Built | 2026-08-18T00:00Z |
| Schema | 2-authored-from-source |
not recorded on the page this object was built from
In this section: Extracted values, and where each came from · References · Included studies · Regulatory documents · Methods and guidance · Sources · Major cardiovascular events, as each of six trials separately defines them · Major cardiovascular events, as each of six trials separately defines them · What was measured · Pooled result · Contributing trials · Endpoint definitions, read from the registry · Named on this review, contributing nothing to its pool
One row per extracted value. Every row carries the value, the verbatim sentence it was read from, a resolvable link to the source, and whether the number was read or derived. Where any of those is absent the row says so rather than omitting the value.
| Trial / outcome | Value as extracted | Verbatim source sentence | Source links | Read or derived |
|---|---|---|---|---|
| SPRINT primary | HR 0.75 (95% CI 0.64 to 0.89) | no source sentence recorded — this value cannot be checked against a quoted line here | NCT01206062 · source | DERIVED by us from the review page's own embedded trial record READ from the page's embedded publishedHR. |
| ACCORD (blood-pressure trial) primary | no effect value held for this outcome | no source sentence recorded — this value cannot be checked against a quoted line here | NCT00000620 · source | DERIVED by us from nothing -- this page holds no value for this trial THIS PAGE CARRIES NO EFFECT FOR THIS TRIAL AT ALL. It is named in the include list and contributes nothing. |
| STEP primary | no effect value held for this outcome | no source sentence recorded — this value cannot be checked against a quoted line here | NCT03015311 · source | DERIVED by us from nothing -- this page holds no value for this trial THIS PAGE CARRIES NO EFFECT FOR THIS TRIAL AT ALL. It is named in the include list and contributes nothing. |
| ESPRIT primary | no effect value held for this outcome | no source sentence recorded — this value cannot be checked against a quoted line here | NCT04030234 · source | DERIVED by us from nothing -- this page holds no value for this trial THIS PAGE CARRIES NO EFFECT FOR THIS TRIAL AT ALL. It is named in the include list and contributes nothing. |
| BPROAD primary | no effect value held for this outcome | no source sentence recorded — this value cannot be checked against a quoted line here | NCT03808311 · source | DERIVED by us from nothing -- this page holds no value for this trial THIS PAGE CARRIES NO EFFECT FOR THIS TRIAL AT ALL. It is named in the include list and contributes nothing. |
| SPS3 primary | no effect value held for this outcome | no source sentence recorded — this value cannot be checked against a quoted line here | NCT00059306 · source | DERIVED by us from nothing -- this page holds no value for this trial THIS PAGE CARRIES NO EFFECT FOR THIS TRIAL AT ALL. It is named in the include list and contributes nothing. |
| Layer | Source | How it was obtained |
|---|
| Comparator | standard blood-pressure target |
|---|---|
| Estimand | time to first event — random-effects |
| Effect scale | reported on the log scale; nothing is pooled on this outcome |
What is confirmed, stated as prominently as what is wrong. (1) the trials are the right trials for the question and every identity is correct: SPRINT, ACCORD, STEP, ESPRIT, BPROAD and SPS3 are the landmark intensive-versus-standard blood-pressure-target trials. Nothing irrelevant is on this list. (2) sprint's own row is sound: 243 of 4,678 against 319 of 4,683, HR 0.75 (0.64 to 0.89), over its registered five-component primary. (3) the published comparison here is genuinely independent, which is worth saying because two other topics this session compared an estimate against itself. This page's benchmark database holds a Lancet 2025 individual-participant-data meta-analysis, HR 0.76 (0.71 to 0.82) over six trials and 80,220 participants, and Bundy 2017 in jama Cardiology, RR 0.84 (0.75 to 0.94) over 42 trials and 144,220 participants. Neither shares a registration with an included trial. The denominator here is two, and it is real. (4) and the external evidence supports the underlying claim. Both independent syntheses find intensive targets better, and the withdrawn 0.79 sits between them. This withdrawal is about what this page can show, not about whether intensive blood-pressure lowering works. A reader wanting the answer should read the Lancet IPD analysis, which is cited on this page and pools the actual participant data. The replacement question is identified and deliberately not taken. The defensible synthesis is over the trials whose composites genuinely share components -- and choosing which, when one counts atrial fibrillation and another counts stroke alone, is an estimand decision. It also duplicates work already done properly at individual-participant level by others. Parked.
Major cardiovascular events, as each of six trials separately defines them. k = 1.
Authored rather than converted, so this name states the finding.
What each trial COUNTED, in its own registry record's words, before anything here was pooled. A sentence saying what HAPPENED is not a sentence saying what was COUNTED, and only the second one licenses a pool. Read from the registry on 2026-08-18. Follow the registration link to disagree with any row.
| Trial | Rank in its own trial | Registered outcome measure | Description, verbatim | Analysis set / window |
|---|---|---|---|---|
| SPRINT NCT01206062 | PRIMARY -- this registration's first primary outcome | Number of Participants With First Occurrence of a Myocardial Infarction (MI), Acute Coronary Syndrome (ACS), Stroke, Heart Failure (HF), or CVD Death | no description registered | 6 years |
| ACCORD (blood-pressure trial) NCT00000620 | PRIMARY -- the BLOOD-PRESSURE trial's primary, index 1 of three on this registration | First Occurrence of Major Cardiovascular Event (MCE) in the Blood Pressure Trial. | Time to first occurrence of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. Primary outcome for Blood Pressure Trial. | 4.7 years |
| STEP NCT03015311 | PRIMARY -- this registration's first primary outcome | Primary composite outcome | A composite end-point comprised of acute coronary syndrome (myocardial infarction and hospitalization for unstable angina), first occurrence of symptomatic stroke ( ischemic or hemorrhagic stroke), hospitalization for decompensated heart failure, coronary revascularization (percutaneous coronary intervention \[PCI\], coronary artery bypass grafting \[CABG\]), atrial fibrillation, and death from cardiovascular causes. | 4 years |
| ESPRIT NCT04030234 | PRIMARY -- this registration's first primary outcome | Number of participants with composite of major CVD events | Composite outcome of myocardial infarction, coronary or non-coronary revascularization, chronic or acute decompensated heart failure hospitalization or emergency department visit, stroke, or death from cardiovascular disease | 4 years |
| BPROAD NCT03808311 | PRIMARY -- this registration's first primary outcome | Major cardiovascular events | Time to the first occurrence of any of the following: non-fatal stroke, non-fatal myocardial infarction, hospitalized or treated heart failure, or cardiovascular deaths | 5 years |
| SPS3 NCT00059306 | PRIMARY -- this registration's first primary outcome | Evidence of clinically defined ischemic stroke (focal neurological deficits persisting for more than 24 hours) confirmed by non-investigational CT or MRI | no description registered | Mean follow up of 4 years |
Five of the six registrations this page includes carry no effect on it at all. Only SPRINT has an embedded value. The index card nevertheless published k=5. Each of the five is listed below with its own registered primary outcome, quoted from its registry record, so a reader can see both that they are missing and what they would have contributed.
| Trial | Why it contributes nothing | What the registry holds |
|---|---|---|
| ACCORD (blood-pressure trial) NCT00000620 | the page holds no effect estimate for this trial | Nonfatal myocardial infarction; Nonfatal stroke; cardiovascular death. Three components -- no heart failure, no acute coronary syndrome, and the infarction and stroke components are NON-FATAL only. This registration declares three separate primaries, one each for its glycaemia, blood-pressure and lipid trials; only the blood-pressure one is relevant here. |
| STEP NCT03015311 | the page holds no effect estimate for this trial | acute coronary syndrome (MI and hospitalisation for unstable angina); symptomatic stroke; hospitalisation for decompensated heart failure; Coronary revascularisation; atrial fibrillation; cardiovascular death. SIX components, and atrial fibrillation appears in no other trial here. |
| ESPRIT NCT04030234 | the page holds no effect estimate for this trial | myocardial infarction; Coronary OR non-coronary revascularisation; heart-failure hospitalisation or emergency-department visit; stroke; cardiovascular death. Five components, and NON-CORONARY revascularisation appears in no other trial here. |
| BPROAD NCT03808311 | the page holds no effect estimate for this trial | non-fatal stroke; non-fatal myocardial infarction; hospitalised or treated heart failure; cardiovascular death. Four components. |
| SPS3 NCT00059306 | the page holds no effect estimate for this trial | Not a composite. This registration declares two separate primary outcomes, each a single event type: 'clinically defined ischemic stroke' and 'hemorrhagic stroke'. It counts stroke recurrence and nothing else. |
In this section: Major cardiovascular events, as each of six trials separately defines them · Forest plot · Risk of bias · GOSH · Trial-sequential analysis · Meta-regression
Drawn from the same stored estimates the table above lists. Box area is proportional to inverse-variance weight.
x-axis range
⬇ SVG (vector) 1 KB ⬇ PNG 4500x580 58 KB
All raster formats were generated at build time from the same SVG as the graphic above (SHA-256, first 16 hex characters: ebebbf1930355e6b), at 600 dpi for a 6-inch print width, on a white ground. They are not screenshots of the page and do not change with the theme you are reading in.
Submission formats written to the figures directory, not embedded here because an uncompressed 600 dpi TIFF is tens of megabytes: EPS (vector, journal's first choice for line art) — forest_fit.eps, 3 KB; TIFF (uncompressed, 600 dpi -- journal fallback) — forest_fit.tiff, 7,646 KB.
⬇ SVG (vector) 1 KB ⬇ PNG 4500x580 58 KB
All raster formats were generated at build time from the same SVG as the graphic above (SHA-256, first 16 hex characters: 288dde177f1bc92a), at 600 dpi for a 6-inch print width, on a white ground. They are not screenshots of the page and do not change with the theme you are reading in.
Submission formats written to the figures directory, not embedded here because an uncompressed 600 dpi TIFF is tens of megabytes: EPS (vector, journal's first choice for line art) — forest_w1.eps, 3 KB; TIFF (uncompressed, 600 dpi -- journal fallback) — forest_w1.tiff, 7,646 KB.
⬇ SVG (vector) 1 KB ⬇ PNG 4500x580 58 KB
All raster formats were generated at build time from the same SVG as the graphic above (SHA-256, first 16 hex characters: 1dad1af0c632952b), at 600 dpi for a 6-inch print width, on a white ground. They are not screenshots of the page and do not change with the theme you are reading in.
Submission formats written to the figures directory, not embedded here because an uncompressed 600 dpi TIFF is tens of megabytes: EPS (vector, journal's first choice for line art) — forest_w2.eps, 3 KB; TIFF (uncompressed, 600 dpi -- journal fallback) — forest_w2.tiff, 7,646 KB.
Changing the range moves the axis window only. The guides stay labelled with the null and the extremes of the plotted intervals, so no plotted value and no printed number differs between these views — and that is checked at build time, not asserted. Ranges not offered because they would crop the data: 0.7 to 1.3.
⬇ SVG (vector) 1 KB
Only the vector format is offered for this figure, by choice: it is line art — discrete marks, glyphs and labels — which SVG reproduces exactly at any size, so a raster would add weight without adding fidelity. The build was able to rasterise; it was asked not to.
Not drawn, because there is nothing to draw it from.
⬇ SVG (vector) 1 KB ⬇ PNG 3500x540 80 KB
All raster formats were generated at build time from the same SVG as the graphic above (SHA-256, first 16 hex characters: 5ec97d733b5a0686), at 600 dpi for a 6-inch print width, on a white ground. They are not screenshots of the page and do not change with the theme you are reading in.
Submission formats written to the figures directory, not embedded here because an uncompressed 600 dpi TIFF is tens of megabytes: EPS (vector, journal's first choice for line art) — gosh.eps, 2 KB; TIFF (uncompressed, 600 dpi -- journal fallback) — gosh.tiff, 5,537 KB.
Deliberately not drawn. Every subset meta-analysis of 1 trials is 1 points; a cloud that small cannot show the multimodality GOSH exists to reveal, and a reader would take the picture as evidence of its absence.
⬇ SVG (vector) 1 KB ⬇ PNG 3500x650 87 KB
All raster formats were generated at build time from the same SVG as the graphic above (SHA-256, first 16 hex characters: 25ed9800fdf56614), at 600 dpi for a 6-inch print width, on a white ground. They are not screenshots of the page and do not change with the theme you are reading in.
Submission formats written to the figures directory, not embedded here because an uncompressed 600 dpi TIFF is tens of megabytes: EPS (vector, journal's first choice for line art) — tsa.eps, 2 KB; TIFF (uncompressed, 600 dpi -- journal fallback) — tsa.tiff, 6,665 KB.
TSA boundaries depend entirely on a target information size that must be pre-specified. This review's protocol registers none, so any boundary drawn here would be a parameter chosen after seeing the data -- which is the practice TSA exists to protect against.
⬇ SVG (vector) 1 KB ⬇ PNG 3500x540 85 KB
All raster formats were generated at build time from the same SVG as the graphic above (SHA-256, first 16 hex characters: 655c850bcb4ad0dc), at 600 dpi for a 6-inch print width, on a white ground. They are not screenshots of the page and do not change with the theme you are reading in.
Submission formats written to the figures directory, not embedded here because an uncompressed 600 dpi TIFF is tens of megabytes: EPS (vector, journal's first choice for line art) — bubble.eps, 2 KB; TIFF (uncompressed, 600 dpi -- journal fallback) — bubble.tiff, 5,537 KB.
The protocol pre-specifies no moderator, and at k = 1 a meta-regression would be fitted on 1 points. Not drawn rather than drawn with a caveat: a bubble plot invites reading a slope, and there is no slope here that any reader should read.
In this section: Summary of findings · Reproducibility artifact · Other recorded qualifications
| Outcome | k | Pooled effect | Certainty |
|---|---|---|---|
| Major cardiovascular events, as each of six trials separately defines them | 1 | not pooled | See comment12 |
| Canonical object | — |
|---|---|
| Registered at | — — |
| Schema | 2-authored-from-source |
| Object last updated | 2026-08-18T00:00Z |
| Source object SHA-256, first 16 hex characters | 9444642ff0d3fdc4 |
| Page generated | 2026-08-28 07:28 UTC |
| Generator build | 59b484ca7. The standard this page was built to is NOT ESTABLISHED: this object carries no build_stamp, so the version above is the standard that exists now, not the one this page was built against. |
This page CANNOT be rebuilt from what is recorded here: no canonical object is recorded and no registered commit is recorded. Each figure on the Analysis tab downloads as an SVG carrying exactly the values shown.
Statements this review records about the limits of what it establishes, which are not shown elsewhere on this page. They are reproduced from the object verbatim and are not summarised.
| What the registry holds that the page does not | Nonfatal myocardial infarction; Nonfatal stroke; cardiovascular death. Three components -- no heart failure, no acute coronary syndrome, and the infarction and stroke components are NON-FATAL only. This registration declares three separate primaries, one each for its glycaemia, blood-pressure and lipid trials; only the blood-pressure one is relevant here. |
|---|---|
| What the registry holds that the page does not | acute coronary syndrome (MI and hospitalisation for unstable angina); symptomatic stroke; hospitalisation for decompensated heart failure; Coronary revascularisation; atrial fibrillation; cardiovascular death. SIX components, and atrial fibrillation appears in no other trial here. |
| What the registry holds that the page does not | myocardial infarction; Coronary OR non-coronary revascularisation; heart-failure hospitalisation or emergency-department visit; stroke; cardiovascular death. Five components, and NON-CORONARY revascularisation appears in no other trial here. |
| What the registry holds that the page does not | non-fatal stroke; non-fatal myocardial infarction; hospitalised or treated heart failure; cardiovascular death. Four components. |
| What the registry holds that the page does not | Not a composite. This registration declares two separate primary outcomes, each a single event type: 'clinically defined ischemic stroke' and 'hemorrhagic stroke'. It counts stroke recurrence and nothing else. |
| Components as the registry states them | myocardial infarction; Acute coronary syndrome; stroke; Heart failure; cardiovascular death. Five components. |
| Components as the registry states them | Nonfatal myocardial infarction; Nonfatal stroke; cardiovascular death. Three components -- no heart failure, no acute coronary syndrome, and the infarction and stroke components are NON-FATAL only. This registration declares three separate primaries, one each for its glycaemia, blood-pressure and lipid trials; only the blood-pressure one is relevant here. |
| Components as the registry states them | acute coronary syndrome (MI and hospitalisation for unstable angina); symptomatic stroke; hospitalisation for decompensated heart failure; Coronary revascularisation; atrial fibrillation; cardiovascular death. SIX components, and atrial fibrillation appears in no other trial here. |
| Components as the registry states them | myocardial infarction; Coronary OR non-coronary revascularisation; heart-failure hospitalisation or emergency-department visit; stroke; cardiovascular death. Five components, and NON-CORONARY revascularisation appears in no other trial here. |
| Components as the registry states them | non-fatal stroke; non-fatal myocardial infarction; hospitalised or treated heart failure; cardiovascular death. Four components. |
| Components as the registry states them | Not a composite. This registration declares two separate primary outcomes, each a single event type: 'clinically defined ischemic stroke' and 'hemorrhagic stroke'. It counts stroke recurrence and nothing else. |
In this section: Summary
Question. Do intensive systolic blood-pressure targets reduce major cardiovascular events? Six landmark trials ask this and register six different composites to answer it.
What was checked. ClinicalTrials.gov protocol records, read 2026-08-18
What was found. 6 registered trials:
| Registration | Trial |
|---|---|
| NCT01206062 | SPRINT |
| NCT00000620 | ACCORD (blood-pressure trial) |
| NCT03015311 | STEP |
| NCT04030234 | ESPRIT |
| NCT03808311 | BPROAD |
| NCT00059306 | SPS3 |
What the trials found. No estimate below is combined with any other; each is the result of a single trial, reported as that trial reported it.
| Trial | Outcome | Result |
|---|---|---|
| NCT01206062 | Major cardiovascular events, as each of six trials separately defines them | HR 0.75 (95% CI 0.64 to 0.89) |
Why no result is pooled. Six trials, six different registered composites. This is the widest endpoint divergence found in this programme, and every difference is stated in the trials' own registry records: sprint counts myocardial infarction, acute coronary syndrome, stroke, heart failure and cardiovascular death -- five. Accord's blood-pressure trial counts nonfatal myocardial infarction, nonfatal stroke and cardiovascular death -- three, with no heart failure and no acute coronary syndrome.
Whether these trials study this subject. Checked against each registration's arm structure on 2026-08-25. 3 of 6 trials were confirmed: the drug is part of the randomised comparison. 3 could NOT be decided this way, because the registered arm names do not name the intervention the way this review does. That is not a pass: they remain unverified, and no other check has looked.
What would change this. A pooled result becomes possible when trials reporting a shared, comparably measured outcome are available.
No pooled estimate, risk-of-bias assessment or certainty rating is published for this question, because there is no combined result for them to describe.
UNSTAMPED — unknown-version. This page carries no build_stamp, so the standard it was built to cannot be established. That is a statement about the record, not a claim that the page is below standard.
Every number on this page is projected from a single canonical object, and each measured cell names the source analysis it was read from. That is what is machine-checked. It does not establish that the underlying sources are right, only that this page faithfully reports them.