Blood pressure medication can prevent heart attacks and strokes – Even in people with normal blood pressure. That is the finding of late breaking study presented in a Hot Line session at ESC Congress 2020.
“Greater drops in blood pressure with medication lead to greater reductions in the risk of heart attacks and strokes,” said principal investigator Professor Kazem Rahimi of the University of Oxford, UK. “This holds true regardless of the starting blood pressure level, in those who previously had a heart attack or stroke, also in those who have not ever had heart disease.”
“The fact that the relative effects are similar for everyone does not mean that everyone should be treated,” he added. “This decision will depend on an individual’s likelihood of suffering cardiovascular disease in the future – there are a number of risk calculators health professionals can use. Other factors to consider are the potential for side effects and the cost of treatment.”
There’s been controversy about whether pharmacological blood pressure lowering is equally beneficial in people with without a prior heart attack or stroke, when blood pressure is below the threshold for hypertension (typically 140/90 mmHg). Evidence from previous studies has been inconclusive, leading to contradictory treatment recommendations round the world.
This was the biggest – and most comprehensive – study conducted to examine these questions. The researchers combined data on people who had participated in a randomized clinical trial and conducted a meta-analysis. The study included 348,854 participants in 48 trials.
Participants were divided into two groups: people who have a prior diagnosis of cardiovascular disease and those without.
Within an average four years of follow-up, every 5 mmHg decrease in systolic blood pressure lowered the relative risk of cardiovascular events by about 10 percent.
Neither the existence of cardiovascular disease nor the level of blood pressure in study entry altered the effect of therapy.
Professor Rahimi said: “The decision to prescribe blood pressure medication should not be based simply on a prior diagnosis of cardiovascular disease or an individual’s current blood pressure. Rather, blood pressure medication should be viewed as an effective tool for reducing cardiovascular risk when an individual’s probability of having a heart attack or stroke is elevated.”