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Hot Line: Blood pressure reduction – lower really is better

Blood pressure (BP) lowering can prevent cardiovascular events even in individuals with normal BP. That’s the finding of one of today’s Hot Lines at ESC Congress 2020.

Pharmacology and Pharmacotherapy

Despite the well­-known benefits of BP-­lowering treatment, controversy remained regarding its differential effects in those with or without a prior diagnosis of cardiovascular disease (CVD) and also in individuals with BP below the common threshold of hypertension diagnosis. As presented by Professor Kazem Rahimi (University of Oxford, UK) on behalf of the Blood Pressure Lowering Treatment Trialists' Collaboration, the analysis described today represents the largest and most detailed study ever carried out to examine these questions.

An individual participant­level data meta­analysis – involving 48 randomised clinical trials and 348,854 participants – was conducted to investigate the effects of BP-­lowering treatment on the risk of fatal or non­fatal major CVD events and death in patients with and without CVD at baseline overall and by baseline levels of BP (systolic BP categories <120, 120–129, 130–139, 140–149, 150–159, 160–169 and ≥170 mmHg).

Over an average 4 years of follow-up, each 5 mmHg reduction in systolic BP lowered the relative risk of major cardiovascular events by about 10%. The risks for stroke, ischaemic heart disease, heart failure and death from CVD were reduced by 13%, 7%, 14% and 5%, respectively. Neither the presence of CVD nor the level of BP at study entry modified the effect of treatment.

“The decision to prescribe BP medication should not be based simply on a prior diagnosis of CVD or an individual’s current BP,” explained Prof. Rahimi. “Rather, BP medication should be viewed as an effective tool for reducing cardiovascular risk when an individual’s probability of having a heart attack or stroke is elevated.”

“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 CVD in the future.”


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The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.