Blood pressure medication could be an effective tool for reducing cardiovascular risk
Blood pressure medication can prevent heart attacks and strokes - even in people with normal blood pressure. That's the finding of late breaking research presented in a Hot Line session today at ESC Congress 2020.
"The fact that the relative effects are similar for everyone does not mean that everyone should be treated," he added. "This decision will depend on an individual's likelihood of suffering cardiovascular disease in the future - there are a number of risk calculators health professionals can use. Other factors to consider are the potential for side effects and the cost of treatment."
There has been controversy about whether pharmacological blood pressure lowering is equally beneficial in people with versus without a prior heart attack or stroke, and when blood pressure is below the threshold for hypertension (typically 140/90 mmHg). Evidence from previous studies has been inconclusive, leading to contradictory treatment recommendations around the world.
This was the largest - and most detailed - study ever conducted to examine these questions. The researchers combined data on individuals who had participated in a randomized clinical trial and conducted a meta-analysis. The study included 348,854 participants from 48 trials.
Participants were divided into two groups: those with a prior diagnosis of cardiovascular disease and those without. Each group was divided into seven subgroups based on systolic blood pressure at study entry (less than 120, 120-129, 130-139, 140-149, 150-159, 160-169, 170 and above mmHg).
Over an average four years of follow-up, each 5 mmHg reduction in systolic blood pressure lowered the relative risk of major cardiovascular events by about 10%. The risks for stroke, ischaemic heart disease, heart failure and death from cardiovascular disease were reduced by 13%, 7% and 14% and 5%, respectively.
Neither the presence of cardiovascular disease nor the level of blood pressure at study entry modified the effect of treatment.
Professor Rahimi said: "The decision to prescribe blood pressure medication should not be based simply on a prior diagnosis of cardiovascular disease or an individual's current blood pressure. Rather, blood pressure medication should be viewed as an effective tool for reducing cardiovascular risk when an individual's probability of having a heart attack or stroke is elevated."