REVIEWS AND META-ANALYSESEffects of blood pressure-lowering drugs in heart failure a systematic review and meta-analysis of randomized controlled trialsPinho-Gomes, Ana-Catarinaa,b; Azevedo, Luish; Bidel, Zeinabi; Nazarzadeh, Milada,b; Canoy, Dextera,b,c; Copland, Emmab,c; Salam, Abdulg; Rodgers, Anthonyf; Kotecha, Dipakd,e; Rahimi, Kazema,b,cAuthor Information aThe George Institute for Global Health bDeep Medicine, Oxford Martin School, University of Oxford cNIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford dInstitute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK eMonash University Centre of Cardiovascular Research and Education, Melbourne, Victoria fThe George Institute for Global Health, University of New South Wales, Sidney, New South Wales, Australia gThe George Institute for Global Health, Hyderabad, Telangana, India hDepartment of Community Medicine, Information and Health Decision Sciences, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal iCollaboration Center of Meta-Analysis Research, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran Correspondence to Kazem Rahimi, The George Institute for Global Health, University of Oxford, Hayes House, 75 George Street, OX1 2BQ Oxford, UK. E-mail: email@example.com Abbreviations: BP, blood pressure; HFrEF, heart failure with reduced ejection fraction; IPD, individual participant data; LVEF, left ventricular ejection fraction; RAAS, renin–angiotensin–aldosterone system Received 29 January, 2019 Revised 25 February, 2019 Accepted 26 February, 2019 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.jhypertension.com). Journal of Hypertension: September 2019 - Volume 37 - Issue 9 - p 1757-1767 doi: 10.1097/HJH.0000000000002094 Buy SDC Metrics Abstract We aimed to combine evidence from all heart failure trials that have investigated the effects of drugs with blood pressure (BP)-lowering properties to assess the extent to which such drugs reduce BP in heart failure, the association between the net change in BP between treatment arms and cause-specific outcomes and whether treatment effects (efficacy and safety) vary according to baseline BP. We conducted a systematic review and meta-analysis including randomized clinical trials of drugs with BP-lowering properties in patients with chronic heart failure with at least 300 patient-years follow-up. We included a total of 37 trials (91 950 patients) and showed that treatment with drugs with BP-lowering properties resulted in a small but significant decrease in SBP in patients with heart failure with no evidence that the efficacy and safety of those drugs varied according to baseline BP. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.