Lowering of TA Useful in CV risk management even at normal levels


Reducing blood pressure with antihypertensive drugs protects against future cardiovascular events (CV), even in people with normal or only slightly elevated blood pressure, concludes a large meta-analysis.

The results showed that each 5 mm Hg reduction in systolic blood pressure reduced the relative risk of CV events by approximately 10% across the baseline blood pressure spectrum, regardless of whether or not the individual had cardiovascular disease. (CVD) or not.

“The message is that pharmacological reduction of blood pressure should be considered as a tool for cardiovascular risk management even when blood pressure is normal or slightly elevated, for primary and secondary prevention of MCV, ”said lead researcher Kazem Rahimi, MD, Oxford University, UK, theheart.org | Cardiology Medscape.

“Advice to patients with normal blood pressure and high risk of cardiovascular disease is that they will likely benefit from taking one or more antihypertensive medications to reduce the risk of suffering a major cardiovascular event in the future,” Rahimi added.

The study was published online this week a The Lancet.

The data, from the collaboration of treatment trials to reduce blood pressure, were presented for the first time at the Virtual Congress of the European Society of Cardiology (ESC) 2020 and reported by theheart.org | Cardiology Medscape In that moment.

For this analysis, Rahimi and colleagues examined individual data at the level of participants in 48 randomized trials of antihypertensive treatment. Participants were divided into seven subgroups based on basal systolic blood pressure (less than 120, 120–129, 130–139, 140–149, 150–159, 160–169, 170, and more than mm Hg).

The analysis included 344,716 patients with ≥1000 patient-years per assigned group.

During an average of 4 years of follow-up, a 5 mm Hg reduction in systolic blood pressure reduced the relative risk of major CV events by about 10%.

The risks for stroke, heart attack, ischemic cardiopathy, and death from cardiovascular disease were reduced by 13%, 13%, 8% and 5%, respectively.

Relative reductions in risk were proportional to the intensity of decreased blood pressure. Neither the presence of MCV nor the blood pressure level at study entry altered the effect of treatment.

Practice change

“This study calls for a change in clinical practice that predominantly limits antihypertensive treatment to people with above-average blood pressure values,” write Rahimi and colleagues.

“Based on this study, the decision to prescribe medications for blood pressure should not be based simply on a prior diagnosis of cardiovascular disease or an individual’s current blood pressure. Rather, it should be considered “Blood pressure medication as an effective tool to prevent cardiovascular disease. when an individual’s cardiovascular risk is high,” they say.

In a linked publisher, Thomas Kahan, MD, PhD, Karolinska Institute, Stockholm, Sweden, notes that similar relative benefits of treatment in primary and secondary prevention indicate that CV risk for a person will be “a determining factor in the absolute benefit of treatment, confirming the importance of risk assessment in individual patients “.

“These findings have important implications for clinical practice and suggest that antihypertensive treatment could be considered for anyone for whom the absolute risk for a future cardiovascular event is sufficient,” Kahan writes.

In a press release from the Science Media Center, Sir Nilesh Samani, MBChB, MD, medical director of the British Heart Foundation, said this study “re-emphasizes the importance of controlling blood pressure as well as possible, to reduce the risk of heart and circulatory diseases. “

“The benefits of lowering blood pressure exist whether you have pre-existing heart disease or not, and this study shows that lowering blood pressure, even if in the normal range, is associated with fewer heart attacks and accidents. cerebrovascular, ”Samani commented.

“That doesn’t mean we have to treat everyone with drugs to lower blood pressure. If someone already has a low risk of heart disease, a 10% reduction in blood pressure can only lead to a small direct benefit.” added Samani. “Ultimately, the decision to treat blood pressure and the target level to be achieved is something that requires a conversation between the patient and the doctor. It is also important to remember that blood pressure can be improved by methods other than medication. , such as exercising and losing weight “.

The meta-analysis was funded by the British Heart Foundation, the National Health Research Institute of the Oxford Biomedical Research Center, the Oxford Martin School and Research and Innovation UK. Rahimi has not revealed any relevant financial relationship. Kahan has received research grants from the Karolinska Institute of Amgen, Medtronic and ReCor Medical. Samani has not revealed any relevant financial relationship.

Lancet. Published online April 29, 2021. Full text, Editorial

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