Changing blood pressure-lowering guidelines 'could save millions of lives', say experts
Blood pressure-lowering drugs should be offered to all individuals at high risk of having a heart attack or stroke regardless of their blood pressure at the start of treatment, according to the largest meta-analysis conducted to date involving over 600,000 people, published in The Lancet.
The authors call for an urgent revision of current blood pressure-lowering guidelines, including those of NICE and the European Society of Hypertension, that have recently relaxed blood pressure targets from 130/85 mmHg to 140/90 mmHg, and for the elderly to even higher targets of 150/90 mmHg. They also recommend a shift from rigid blood pressure targets to individualised risk-based targets, even when blood pressure is below 130 mmHg before treatment.
In this study, Professor Kazem Rahimi from The George Institute for Global Health, based at the Oxford Martin School, University of Oxford, and colleagues analysed the findings of 123 large-scale randomised trials comparing different blood pressure targets from January 1966 to July 2015.
They found that treatment with any of the main classes of blood pressure-lowering drugs significantly the reduced risk of major cardiovascular events, stroke, heart failure, and death proportional to the extent to which blood pressure was lowered. Overall, every 10 mmHg reduction in systolic blood pressure reduced the risks of major cardiovascular disease events and heart disease by about one fifth, and stroke and heart failure by about a quarter, and the risk of death from any cause by 13%.