Antihypertensive medication can prevent myocardial infarction and strokes even in normotensive individuals.
This conclusion, based on results of a meta-analysis of participants from 48 trials, was presented at the virtual European Society of Cardiology (ESC) Congress 2020.
Kazem Rahimi, MD, of the University of Oxford, UK, said in an ESC press release: “The decision to prescribe blood pressure medication should not be based simply on a prior diagnosis of cardiovascular disease or current blood pressure. Rather, blood pressure medication should be viewed as an effective tool for reducing cardiovascular risk when the probability of having a heart attack or stroke is elevated.”
Whether pharmacological blood pressure lowering is equally beneficial in individuals with vs without prior heart attack or stroke, and when blood pressure is below the threshold for hypertension (typically 140/90 mmHg) has been controversial. Evidence has been inconclusive, leading to contradictory treatment recommendations.
In the largest and most detailed study to examine these questions, Dr. Rahimi and colleagues performed a meta-analysis of subjects of randomized clinical trials.
A total of 348,854 participants from 48 trials were divided into two groups: those with a prior diagnosis of cardiovascular disease and those without. Each group was divided into seven subgroups based on systolic blood pressure at study entry (<120, 120-129, 130-139, 140-149, 150-159, 160-169, ≥170 mm Hg).
Over an average of 4 years, each 5-mm Hg reduction in systolic blood pressure lowered the relative risk of major cardiovascular events by approximately 10%.
Risks of stroke, ischemic heart disease, heart failure, and death from cardiovascular disease were reduced by 13%, 7%, 14%, and 5%, respectively.
Neither the presence of cardiovascular disease nor the level of blood pressure at study entry modified the effect of treatment.
“Greater drops in blood pressure with medication lead to greater reductions in the risk of heart attacks and strokes,” said Dr. Rahimi.
“This holds true regardless of the starting blood pressure level, in patients who suffered a previous heart attack or stroke, as well as in those who never have exhibited heart disease. The fact that the relative effects are similar for everyone does not mean that everyone should be treated,” he added.
“This decision will depend on an individual’s likelihood of suffering cardiovascular disease in the future. A number of risk calculators are available. Other factors to consider are the potential for side effects and the cost of treatment.”
Finally, Dr. Rahimi concluded: “The decision to prescribe antihypertensive medication should be based not simply on a prior diagnosis of cardiovascular disease or current blood pressure.”
“Rather,” he asserted, “antihypertensive medication should be viewed as an effective tool for reducing cardiovascular risk in patients with elevated probability of myocardial infarction or stroke.”