Using medications to lower blood pressure reduces the risk for cardiovascular events — like a stroke or heart attack — regardless of whether someone has a history of cardiovascular disease or how high their blood pressure is before treatment, according to a new analysis published in the journal The Lancet.
While taking drugs to help reduce blood pressure is a common and uncontroversial practice for people with moderate to severe hypertension (high blood pressure), many people with high-normal blood pressure are reluctant to take these medications, if their doctors even consider prescribing them. What’s more, the benefits of taking drugs to lower blood pressure in people without a history of cardiovascular disease — especially those with close to normal blood pressure — haven’t been clear based on past studies. For the latest analysis, the researchers sought to find out if the cardiovascular benefits of blood pressure drugs also applied to people with normal or high-normal blood pressure, and those without a history of cardiovascular disease.
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The researchers combined data from 48 different studies, each of which was a randomized trial of at least one blood pressure drug and included both an intervention group and a control group that took either a placebo (inactive pill) or another blood pressure drug or drug regimen. Study participants were classified as having preexisting cardiovascular disease — a documented stroke or heart attack, or ischemic heart disease — and also divided into seven systolic blood pressure (the “top number” measured during heartbeats) categories. The main outcome the researchers were interested in was major cardiovascular events, defined as a heart attack, a stroke, ischemic heart disease, or heart failure resulting in death or hospital admission.
Blood pressure and cardiovascular risk reduction
Out of a total of 344,716 participants, 42,324 had at least one major cardiovascular event during an average follow-up period of 4.15 years. In participants without a history of cardiovascular disease, the rate of major cardiovascular events was 25.9 per 1,000 person-years for the blood pressure intervention group, compared with 31.9 for the control group. For those with a history of cardiovascular disease, the rate of major cardiovascular events was 36.0 for the intervention group and 39.7 for the control group. But a more consistent effect from lowering blood pressure emerged when the researchers looked at how cardiovascular outcomes were related to actual blood pressure reductions.
For every 5 mm Hg reduction in systolic blood pressure, the risk for a major cardiovascular event was 9% lower for people without a history of cardiovascular disease, and 11% lower for those with preexisting cardiovascular disease. What’s more, there were no differences in these risk reductions depending on the starting point for systolic blood pressure — which ranged among study participants from less than 120 to greater than 170 mm Hg.
“These findings suggest that a fixed degree of pharmacological blood pressure lowering is similarly effective for primary and secondary prevention of major cardiovascular disease, even at blood pressure levels currently not considered for treatment,” the researchers wrote. “Physicians communicating the indication for blood pressure lowering treatment to their patients should emphasize its importance on reducing cardiovascular risk rather than focusing on blood pressure reduction itself.”
Want to learn more about protecting your heart? Read “Be Heart Smart: Know Your Numbers,” “Does Diabetes Hurt Your Heart?” “Fight Off Heart Disease With These Five Heart-Healthy Foods” and “Lower Your Risk of Heart Disease.”
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