People with low BP but at risk of cardiovascular disease could benefit from BP treatment.
The benefits of treating high BP with BP-lowering medications are well established.
But uncertainty remains about whether to treat those who currently have low BP but are at risk of cardiovascular events, and which drugs to use.
The UK's National Institute for Health and Care Excellence (NICE) and the European Society of Hypertension have recently moved blood pressure targets from 130/85 mmHg to 140/90 mmHg, and for the elderly to even higher targets of 150/90 mmHg.
Call to review and personalize targets
The authors of the present study call for an urgent revision of these and other current blood pressure-lowering guidelines.
They also recommend a shift from rigid blood pressure targets to individualized risk-based targets, even when blood pressure is below 130 mmHg before treatment.
Prof. Kazem Rahimi, from The George Institute for Global Health at the University of Oxford in the UK, and colleagues analyzed the findings of 123 large-scale randomized trials comparing different blood pressure targets for over 600,000 people from January 1966-July 2015.
They found that treatment with any of the main classes of blood pressure-lowering drugs significantly reduced the risk of major cardiovascular events, stroke, heart failure and death, proportional to the extent to which blood pressure was lowered.
Overall, every 10 mmHg reduction in systolic blood pressure reduced the risks of major cardiovascular disease (CVD) events and heart disease by about 20%, of stroke and heart failure by about 25% and the risk of death from any cause by 13%.
The reductions were similar across a wide range of high-risk patients, including those with a history of CVD, heart failure, diabetes and kidney disease, regardless of whether their blood pressure was already low (less than 130 mmHg) to begin with.
The five major drug classes examined were found to be equally effective at protecting against cardiovascular events, but some classes were more effective than others for specific outcomes; for example, calcium channel blockers seemed better for stroke, and diuretics were better for heart failure prevention.
Prof. Rahimi says:
"Our findings clearly show that treating blood pressure to a lower level than currently recommended could greatly reduce the incidence of cardiovascular disease and potentially save millions of lives if the treatment was widely implemented."
He argues that results provide strong support for reducing systolic blood pressure to less than 130 mmHg, and recommends offering blood pressure-lowering drugs to all patients at high risk of a heart attack or stroke, for whatever reason.
In a linked comment, Prof. Stephane Laurent, from the University Paris Descartes, in Paris, France, says that since lowering BP seems safe and beneficial to patients, it could be applied to high-risk patients, especially now that uncontrolled hypertension is a worldwide problem.
Medical News Today recently reported on research showing that men who take alpha blockers run a higher risk of stroke.