Treating blood pressure below current targets significantly reduces the risk of cardiovascular events and death, regardless of blood pressure before treatment, according to researchers.
Anti-hypertensives should be offered to all individuals at high risk of having a heart attack or stroke, regardless of their blood pressure at the start of treatment, according to the authors of the largest meta-analysis conducted to date involving over 600,000 people.
“Our findings clearly show that treating blood pressure to a lower level than currently recommended could greatly reduce the incidence of CVD”
They called for an urgent revision of current blood pressure-lowering guidelines, including those published by the National Institute for Health and Care Excellence and the European Society of Hypertension.
The study authors, most of whom were from the UK, also recommended a shift from rigid blood pressure targets to individualised risk-based targets, even when blood pressure was below 130mmHg before treatment.
The researchers noted that the benefit of lowering blood pressure in patients with hypertension was well established, but said there was previously uncertainty about whether to treat people with lower blood pressures or with previous disease, and which drugs to use.
In their study, published today in The Lancet, they analysed the findings of 123 large-scale randomised trials comparing different blood pressure targets from January 1966 to July 2015.
They found that treatment with any of the main classes of blood pressure-lowering drugs significantly the reduced risk of major CVD events and death proportional to the extent to which blood pressure was lowered.
Overall, every 10mmHg reduction in systolic blood pressure reduced the risks of major CDV events and heart disease by about one fifth, and stroke and heart failure by about a quarter, and the risk of death from any cause by 13%.
Importantly, they noted the reductions in disease were similar across a wide range of high risk patients, including those with a history of CVD, heart failure, diabetes, and kidney disease, irrespective of whether their blood pressure was already less than 130mmHg.
In general, none of the five major drug classes examined was found to be better than another at protecting against cardiovascular events. However, they noted a few exceptions:
- an extra protective effect of calcium channel blockers in preventing stroke
- an extra effect of diuretics in preventing heart failure
- a weaker effect of beta blockers in preventing major cardiovascular outcomes, stroke, and renal failure
Lead author Professor Kazem Rahimi, from The George Institute for Global Health at Oxford University, said: “Our findings clearly show that treating blood pressure to a lower level than currently recommended could greatly reduce the incidence of cardiovascular disease and potentially save millions of lives if the treatment was widely implemented.
“The results provide strong support for reducing systolic blood pressure to less than 130mmHg, and blood pressure-lowering drugs should be offered to all patients at high risk of having a heart attack or stroke, whatever their reason for being at risk,” he added.
The study also involved researchers from the University of Manchester, King’s College Hospital NHS Foundation Trust, and the University of Sydney.