Blood Pressure Treatment Not Just for Those with High BP, Meta-Analysis Suggests

By Amy Orciari Herman

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Blood pressure (BP)–lowering treatment is associated with lower risk for cardiovascular (CV) events across a wide range of BP levels and in patients with and without CV disease, according to a meta-analysis in The Lancet.

Researchers examined individual-patient data on some 345,000 adults who were randomized to different BP-lowering or control regimens across nearly 50 trials. Patients' baseline BP levels varied widely, and those with and without CV disease were included.

During a median 4 years' follow-up, 12% of participants experienced at least one major CV event. Among those with CV disease at baseline, a 5-mm-Hg reduction in BP was associated with an 11% reduction in risk for CV events. For those without prevalent CV disease, the risk reduction was 9%. Significant benefits were seen regardless of baseline BP, even at levels below 120 mm Hg.

The researchers call for a revision of guidelines that use BP level and CV disease status to guide BP-lowering therapy. Rather, they suggest such treatment should be guided by the patient's absolute CV risk. They write, "By considering antihypertensives as a tool for reducing cardiovascular risk, rather than simply reducing blood pressure, clinicians are no longer required to make decisions according to an arbitrary and confusing classification of hypertension." The researchers also note that "recommendations that specify ... a floor level for blood pressure reduction are not substantiated by this study."

A commentator adds, "These findings have important implications for clinical practice, and suggest that antihypertensive treatment might be considered for any person for whom the absolute risk for a future cardiovascular event is sufficiently high."