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
Review of 48 RCTs (n=344716) suggests that a fixed degree of pharmacological blood pressure lowering is similarly effective for primary and secondary prevention of major cardiovascular disease, even at blood pressure levels currently not considered for treatment.
Source:
The Lancet
SPS commentary:
Over an average 4 years of follow-up, a 5 mm Hg reduction in systolic blood pressure lowered the relative risk of major cardiovascular events by 10%. Hazard ratios (HR) associated with a reduction of systolic blood pressure by 5 mm Hg for a major cardiovascular event were 0.91, 95% CI 0.89–0·94 for participants without previous cardiovascular disease and 0.89, 0.86–0.92, for those with previous cardiovascular disease
Commentary is provided which discusses the benefit the results show that antihypertensive drug treatment is proportional to the intensity of blood pressure reduction, and that the magnitude of relative (and absolute) risk reduction is similar across baseline systolic blood pressure levels from less than 120 mm Hg to more than 170 mm Hg, extending observations from epidemiological studies. It also discusses the limitations of the review as all eligible trials were unable to be included therefore findings might not be generalisable to patient groups with concomitant conditions not studied in these analyses.