Lowering blood pressure below current targets reduces a range of cardiovascular risks

By John Murphy, MDLinx
Published November 11, 2015

Key Takeaways

Current hypertension guidelines should be revised to recommend more intensive blood pressure-lowering treatment in high-risk patient groups, a wide-scale study concluded. This large meta-analysis, published online November 6, 2015 in The Lancet, found that intensive blood pressure-lowering treatment reduces the risk of major cardiovascular events across various patient groups.

“Several major clinical guidelines on managing high blood pressure, including those of NICE (National Institute for Health and Care Excellence) and the European Society of Hypertension, have recently raised blood pressure targets from 130/85 mmHg to 140/90 mmHg for high-risk patients. But our robust evidence clearly shows that treating blood pressure to a lower level than currently recommended targets results in better health outcomes for patients,” said lead author Anthony Rodgers, MBChB, PhD, Professor of Global Health at The George Institute of Global Health, in Sydney, Australia.

This meta-analysis, which included nearly 45,000 people from 19 trials held from 1950 to 2015, found that intensive blood pressure lowering provided greater vascular protection for a range of patients. “A key finding was the consistency of findings across major patient groups—those with cardiovascular disease, diabetes, renal disease, and also those with just hypertension,” said co-author Jicheng Lv, MD, from the Renal Division of Peking University First Hospital, in Beijing, China.

Dr. Lv added, “This is a really important area—cardiovascular deaths are our leading killer, most occur in high-risk people who have already had a ‘warning sign’ and most occur among people with blood pressure levels which have, until now, widely been regarded as acceptable.”

More intensive blood pressure-lowering resulted in average blood pressure levels of 133/76 mm Hg, compared with 140/81 mm Hg in the less intensive treatment group, the systematic review showed. Intensive blood pressure-lowering treatment also reduced the risk for major cardiovascular events by 14%, myocardial infarction by 13%, stroke by 22%, albuminuria by 10%, and retinopathy progression by 19%.

However, more intensive treatment had no clear effects on risk of heart failure, cardiovascular death, end-stage kidney disease, or total mortality. Also, more intensive blood pressure control nearly tripled the risk of hypotension, including severe episodes of hypotension compared with standard regimens. Nevertheless,“there was no suggestion that these adverse effects would outweigh the benefits of treatment in high-risk patient populations,” the authors wrote.

“These adverse effects are important but do not outweigh the benefits of lowering blood pressure using intensive treatment in high-risk patients,” Dr. Rodgers noted. “However, much more research is needed to determine how best to easily and safely achieve and maintain greater blood pressure reductions. Improving treatment rates and long-term adherence is critical for the success of any intervention. Patients are also likely to benefit non-drug approaches such as weight loss and restricting salt intake.”

The authors concluded, “Existing clinical guidelines should be revised accordingly, to recommend more intensive blood pressure-lowering treatment in high-risk patient groups."

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