Lowering blood pressure is more beneficial than previously thought
Blood pressure medication can prevent heart attacks and strokes, even in people with normal blood pressure. This is the finding of the latest research presented in a Hot Line session a few days ago at ESC Congress 2020.
“Greater decreases in blood pressure with drugs lead to greater reductions in the risk of heart attacks and strokes,” said lead investigator Professor Kazem Rahimi of Oxford University in the United Kingdom. This is true regardless of the initial blood pressure level, in people who have previously had a heart attack or stroke, but also in people who have never had a heart disease.
„That doesn’t mean everyone should be treated with this kind of medication,” he added. “This decision will depend on a person’s likelihood of suffering from cardiovascular disease in the future – there are a number of risk calculators that healthcare professionals can use. Other factors to consider are the potential for side effects and the cost of treatment.”
There have been pharmacological controversies about lowering blood pressure and if it is equally beneficial in people with a heart attack or previous stroke, versus those without and when their blood pressure is below the hypertension threshold (usually 140/90 mmHg). Evidence from previous studies has been inconclusive, leading to conflicting treatment recommendations worldwide.
This study was the largest – and the most detailed – ever conducted to examine these questions. The researchers combined data from people who participated in a randomized clinical trial and performed a meta-analysis. The study included 348,854 participants from 48 studies.
On average, after four years of investigation, each 5mmHg reduction in systolic blood pressure reduced the relative risk of major cardiovascular events by approximately 10%. The risks for stroke, ischemic heart disease, heart failure and death from cardiovascular disease were reduced by 13%, 7%, 14% and 5%, respectively.
Neither the presence of cardiovascular disease, nor the level of blood pressure at the beginning of the study changed the effect of the treatment.
Professor Rahimi said: “The decision to prescribe blood pressure medication belongs only to the specialist and should not simply be based on a prior diagnosis of an individual’s cardiovascular disease or current blood pressure. Rather, blood pressure medication should be an effective tool for reducing cardiovascular risk when the likelihood of having a heart attack or stroke is increased.”
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