According to new research published in Lancet, any individual at a high risk of a cardiovascular event must be administered blood pressure lowering drugs.
High blood pressure (BP) is the major cause of heart problems and stroke. It impacts over 1 billion individuals globally and kills 9.4 million each year.
The advantages of treating high BP with BP-lowering drugs are well set up.
But uncertainty remains about whether to treat those who presently have low BP but are at risk of cardiovascular events, and which medicines to use.
European Society of Hypertension and the UK’s National Institute for Health and Care Excellence (NICE) have recently moved blood pressure targets from 130/85 mmHg to 140/90 mmHg, and for the older people to even higher targets of 150/90 mmHg.
Call to examine and personalize targets
The authors of the present research call for an immediate revision of these and other present blood pressure-lowering guidelines.
They also suggest a shift from rigid blood pressure objectives to personalized risk-based targets, even when blood pressure is under 130 mmHg before therapy.
Prof. Kazem Rahimi, from The George Institute for Global Health and colleagues assessed the results of 123 large-scale randomized trials evaluating various blood pressure targets for over 600,000 individuals from January 1966-July 2015.
They identified that therapy with any of the main classes of blood pressure-lowering medicines considerably decreased the risk of major cardiovascular events, stroke, heart failure and death, proportional to the level to which blood pressure was reduced.
Over-all, every 10 mmHg decrease in systolic blood pressure decreased the risks of major cardiovascular disease (CVD) events and heart disease by around 20%, of stroke and heart failure by around 25% and the risk of death from any cause by 13%.
The reductions were similar throughout a wide range of high-risk patients, including those with a history of CVD, heart failure, diabetes and kidney disease, irrespective of whether their BP was already low (less than 130 mmHg) to begin with.
The 5 major drug classes analyzed were identified to be equally effective at protecting against cardiovascular events, but some classes were more successful than others for particular outcomes; for instance, calcium channel blockers appeared superior for stroke, and diuretics were better for heart failure prevention.
Prof. Rahimi states that:
“Our results clearly show that reducing with blood pressure to a lower level than presently suggested could significantly decrease the incidence of cardiovascular disease and possibly save millions of lives if the therapy was widely implemented.”
He states that outcomes offer strong support for decreasing systolic blood pressure to under 130 mmHg, and suggests providing blood pressure-lowering drugs to all sufferers at high risk of a heart attack or stroke, for whatever cause.