Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis
Analysis (48 RCTS; n=344,716) found that each 5mmHg reduction in systolic BP reduced risk for a major CV event by 9% (HR 0.91; 95% CI 0.89–0.94) in those without previous CVD and by 11% (0.89, 0.86–0.92) in those with previous CVD, even in those with normal BP.
Source:
The Lancet
SPS commentary:
This study was conducted by the by the Blood Pressure Lowering Treatment Trialists' Collaboration. The researchers divided participants into two groups based on previous history of CVD, and then each group further into 7 categories according to their systolic blood pressure at study entry. In stratified analyses, they found that treatment effects were similar regardless of baseline BP and presence of CVD. The authors say that their findings call for a change in clinical practice, and suggest that antihypertensives be viewed as treatment options for the prevention of CVD regardless of blood pressure level and previous history of CVD.
A related Comment notes this is the largest meta-analysis to date of individual participant-level data for the effects of antihypertensive treatment stratified by initial BP and prevalent CVD. The observed similar relative benefits of treatment in primary and secondary prevention indicate the CV risk of an individual will be the major determinant of the absolute benefit of treatment, and suggest that antihypertensive treatment might be considered for any person for whom the absolute risk of a future cardiovascular event is sufficiently high.