Should Blood Pressure Be Lowered in All Patients at High Risk for Adverse Cardiac Events?

Patient selection and treatment targets for blood pressure (BP) reduction remain controversial, particularly among patients with high-normal BP and without previous cardiovascular (CV) disease. Researchers combined patient-level data from 48 large randomized, controlled trials (344,000 total patients) in which BP-lowering medications were compared with placebo or with one another, or in which more-intensive versus less-intensive treatment regimens were evaluated. Trials that were done exclusively in patients with heart failure were excluded. Twenty percent of patients with previous CV disease and 8% of patients without previous CV disease had baseline systolic BP <130 mm Hg.

After a median 4 years of follow-up, reduction of systolic BP by 5 …