Blood pressure-lowering medication can prevent heart attacks and strokes – even in people with normal blood pressure, based on new research from the BPLTTC trial presented at ESC Congress 2020. However, principal investigator Kazem Rahimi, MD, of the University of Oxford, UK, said "the fact that the relative effects are similar for everyone does not mean that everyone should be treated."

BPLTTC researchers conducted a meta-analysis of data from 348,854 participants from 48 clinical trials from around the world. Participants were divided into two groups: those with a prior diagnosis of cardiovascular disease and those without. Each group was then further divided into seven subgroups based on systolic blood pressure at study entry (less than 120, 120-129, 130-139, 140-149, 150-159, 160-169, and 170 and above mmHg). The average follow-up was four years.

Overall results showed a reduction in relative risk of major cardiovascular events by roughly 10% for each 5 mmHg reduction in systolic blood pressure. Risk for stroke, ischemic heart disease, heart failure, and death from cardiovascular disease were reduced by 13%, 7%, and 14%, and 5%, respectively. According to Rahimi, there was no evidence that proportional effects varied by baseline BP values, down to the lowest systolic BP category of <120 mmHg, in both primary and secondary prevention settings.

While BP-lowering medication is known to be an effective strategy for preventing cardiovascular disease in patients with high or very high BP, conflicting guideline recommendations and uncertainty around the effects of medication on patients below the typical threshold for hypertension, has led to variability in care worldwide. Based on the BPLTTC study findings, Rahimi suggested the decision to prescribe BP-lowering medication should not be based simply on a prior diagnosis of cardiovascular disease or an individual's current BP, but rather used as "risk modifying treatments for prevention of incident or recurrent cardiovascular events, regardless of BP values at baseline." He notes the availability of number of risk calculators available to clinicians, as well as the need to consider other factors, including potential side effects and treatment costs when prescribing BP-lowering medication.

Note: ACC's Primary Prevention Guideline Hub includes a number of clinician and patient resources, including the ASCVD Risk Estimator Plus mobile app, guideline summaries, patient-focused infographics and more, to help guide decision-making.

Clinical Topics: Geriatric Cardiology, Prevention

Keywords: ESC Congress, ESC20, Geriatrics, Primary Prevention, Blood Pressure, Hypotension

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