Hypertension Treatment Beneficial Irrespective of Baseline Blood Pressure

Treatment to lower blood pressure (BP) levels reduces the risk of major cardiovascular disease (CVD) events regardless of initial BP, according to a new study.

Researcher at the University of Oxford (United Kingdom), the University of Sydney (Australia), and other institutions affiliated with the George Institute for Global Health (Sydney, Australia) conducted a systematic review and meta-analysis of large-scale BP lowering trials published between Jan 1, 1966, and July 7, 2015. In all, a total of 123 studies with a minimum of 1,000 patient-years of follow-up were included, involving 613,815 participants.

The results showed that every 10 mmHg reduction in systolic BP significantly reduced the risk of major CVD events, coronary heart disease (CHD), stroke, and heart failure. In trials with higher and lower mean baseline systolic BP, similar proportional risk reductions were observed, with an overall 13% reduction in all-cause mortality; the effect on renal failure, however, was not significant. The researchers found no clear evidence for variation in proportional risk reduction in major CVD based on baseline disease history, with the exception of diabetes and chronic kidney disease (CKD), which correlated with smaller risk reductions.

From a disease management point of view, different classes of drugs to treat BP showed varying effects. For example, β-blockers were found to be inferior for the prevention of major CVD events, stroke, and renal failure, while calcium channel blockers were superior to other drugs for stroke prevention. But for the prevention of heart failure, calcium channel blockers were found to be inferior, while diuretics were superior to other drug classes. The study was published on December 23, 2015, in the Lancet.

“Blood pressure lowering significantly reduces vascular risk across various baseline levels and co-morbidities,” concluded lead author Dena Ettehad, MSc, of Oxford University, and colleagues of the George Institute for Global Health. “Our results provide strong support for lowering blood pressure to systolic blood pressures less than 130 mmHg and providing blood pressure lowering treatment to individuals with a history of cardiovascular disease, coronary heart disease, stroke, diabetes, heart failure, and chronic kidney disease.”

Related Links:
University of Oxford
University of Sydney
George Institute for Global Health