Antihypertensives also reduce CV risk in people with normal blood pressure

New research from the BPLTTC study supports the notion that people with normal blood pressure can prevent heart attacks and strokes by taking prophylactic blood pressure-lowering medication. These data will add fuel to the discussion of current and future blood pressure thresholds.

Prof. Kazem Rahimi (University of Oxford, UK) presented a meta-analysis of data from 348,854 participants from 48 clinical trials [1]. Participants were divided according to whether they had a prior diagnosis of cardiovascular disease, then further stratified according to 1 of 7 blood pressure groups ranging from systolic blood pressures of <120 mmHg up to ≥170 mmHg at study entry.

With an average follow-up of 4 years, the investigators noted a progressive reduction in relative risk of major cardiovascular events by roughly 10% for each 5 mmHg reduction in systolic blood pressure, including for the lowest systolic blood pressure category of <120 mmHg, in both primary and secondary prevention settings (see Figure). Risk for stroke, ischaemic heart disease, heart failure, and death from cardiovascular disease was reduced by 13%, 7%, 14%, and 5%, respectively. The benefits were similar along the entire range of systolic blood pressures.

Figure: Effects on major cardiovascular events for each 5 mmHg SBP reduction, by CVD status at baseline [1]

CI, confidence interval; CVD, cardiovascular disease; HR, hazard ratio; SBP, systolic blood pressure.

In his interpretation of these results, Prof. Rahimi cautioned that “the fact that the relative effects are similar for everyone does not mean that everyone should be treated.” He went on to suggest the decision to prescribe blood pressure-lowering medication should not be based simply on a prior diagnosis of cardiovascular disease or an individual’s current blood pressure, but rather used as “risk-modifying treatments for prevention of incident or recurrent cardiovascular events, regardless of blood pressure values at baseline.”

 

1. 1. Rahimi K, et al. BPLTTC – Blood pressure lowering for prevention of cardiovascular events across different levels of blood pressure. Hot Line 3 session, ESC 2020 E-Congress, 31 Aug.

 

Posted on 5 November, 20205 August, 2021