Many more people could benefit from blood pressure lowering medication

30 April 2021

Adobe Stock 245783541
© Adobe Stock
The Lancet has published new research showing that blood pressure-lowering medication can prevent serious cardiovascular conditions such as strokes, heart failure and heart attacks even in adults with normal blood pressure.

The study, led by Professor Kazem Rahimi, Professor of Cardiovascular Medicine and Population Health and Lead Researcher on the Oxford Martin Programme on Deep Medicine, found the beneficial effects of treatment were similar regardless of the starting blood pressure level, in both people who had previously had a heart attack or stroke and in those who had never had heart disease. The findings have immediate and important implications for global clinical guidelines that typically limit blood pressure-lowering treatment to individuals with high blood pressure (usually above 140/90 mmHg).

“Our findings are of great importance to the debate concerning blood pressure treatment”, says Professor Rahimi. “This new and best available evidence tells us that decisions to prescribe blood pressure medication should not be based simply on a prior diagnosis of cardiovascular disease or an individual’s blood pressure level. Instead, medication should be viewed as an effective tool for preventing cardiovascular disease in people at increased risk of developing heart disease or stroke. Clinical guidelines should be changed to reflect these findings.”

He cautions, “We’re not saying that everyone must begin treatment. The decision will depend on an individual’s risk factors for developing cardiovascular disease, the potential for side effects and patient choice.”

Clinical guidelines should be changed to reflect these findings.

The analysis pooled data from 344,716 adults (average age 65 years) in 48 randomised trials to explore the effects of blood pressure-lowering medications. Participants were separated into two groups: those with a prior diagnosis of cardiovascular disease (157,728 participants – secondary prevention group) and those without (186,988 – primary prevention group, without cardiovascular disease). Around 20% of participants with prior cardiovascular disease and 8% of those who had never had cardiovascular disease had normal or high-normal systolic blood pressure at the start of the trials.

Over an average of four years follow-up, 42,324 participants had at least one major cardiovascular event (heart attack, stroke, heart failure, or death from cardiovascular disease). For every 5 mmHg reduction in systolic blood pressure, the risk of developing major cardiovascular disease fell by around 10% (18,287 vs 24,037 major cardiovascular disease in the intervention and comparator groups, respectively), stroke by 13% (6,005 vs 7,767), heart failure by 13% (3,249 vs 4,584), ischaemic heart disease by 8% (8,307 vs 11,145), and death from cardiovascular disease by 5% (4,825 vs 6,110).

The beneficial effects of the treatment did not differ based on a history of having had cardiovascular disease or the level of blood pressure at study entry.