Medication May Be Offered for Mild High Blood Pressure

Both a scientific statement from the American Heart Association and an individual participant-level data meta-analysis support that pharmacological blood pressure (BP) lowering is effective for primary and secondary prevention of major cardiovascular disease (CVD), even at BP levels currently not considered for treatment. The statement provides evidence suggesting that in all patients with stage 1 high BP not achieving goal BP (<130/80 mm Hg) within 6 months, lifestyle therapy should be continued, and consideration given to the addition of medication. The individual participant-level data meta-analysis included 344 716 participants from 48 randomized clinical trials published between 1972 and 2013. The relative effects of BP-lowering treatment were proportional to the intensity of systolic BP reduction. After a median 4·15 years’ follow-up, 12·3% had at least one major CVD event. In participants without previous CVD at baseline, the incidence rate for developing a major CVD event per 1000 person-years was 31·9 in the comparator group and 25·9 in the intervention group. In participants with previous CVD at baseline, the corresponding rates were 39·7 and 36·0, in the comparator and intervention groups, respectively. Neither the presence of CVD or the level of BP at study entry (ranging from <120 to ≥170 mm Hg) modified the effect of treatment. Hazard ratios associated with a reduction of systolic BP by 5 mm Hg for a major CVD event were 0·91 for participants without previous CVD and 0·89 for those with previous CVD. The findings are in line with epidemiological studies for a log-linear relationship between BP and CVD risk across the full physiological BP range, and provide compelling evidence from randomized trials for the beneficial effects of BP-lowering treatment across the spectrum of systolic BP in people with or without CVD, and emphasize the importance of using multivariable risk prediction tools but not a common BP threshold for all individuals. Source: https://www.ahajournals.org/; https://www.thelancet.com/