Study data published in the Lancet support lowering systolic blood pressures to less than 130 mm Hg and providing blood pressure lowering treatment to people with a history of cardiovascular disease, coronary heart disease, stroke, diabetes, heart failure and chronic kidney disease. Researcher Kazem Rahimi remarked "our findings clearly show that treating blood pressure to a lower level than currently recommended could greatly reduce the incidence of cardiovascular disease and potentially save millions of lives if the treatment was widely implemented," adding "we would probably be talking about recommending medication for two in four adults – about half the adult population."
The researchers analysed results of 123 large-scale blood pressure lowering trials, published between Jan 1, 1966, and July 7, 2015 which included a total of 613 815 participants. Findings showed that every 10 mm Hg reduction in systolic blood pressure significantly reduced the risk for major cardiovascular disease events, coronary heart disease, stroke and heart failure, which led to a 13-percent reduction in all-cause mortality. The authors noted that similar proportional risk reductions were found in studies with both higher and lower mean baseline systolic blood pressure.
Further, the researchers found that while beta blockers were inferior to other drugs for the prevention of major cardiovascular disease events, stroke and renal failure, calcium channel blockers were superior to other drugs for the prevention of stroke. Moreover, data suggested that calcium channel blockers were inferior to other drug classes for the prevention of heart failure while diuretics were found to be superior.
The National Institute of Health and Care Excellence currently recommends blood pressure lowering treatment for people with blood pressure higher than 140/90 mmHg, or 150/90mmHg among those aged 80 and over. However, Rahimi said "I think we should be looking urgently at the guidance," adding age was one of the strongest risk determinants, with most people aged in their 60s likely to benefit from such drugs. "What the precise risk threshold is depends what the health service is prepared to pay – it’s a discussion about the risks and benefits," Rahimi noted. A spokesman for NICE said its current guidance would be reviewed next year.
In July 2014, NICE issued an update to its guidelines on lipid modification, recommending that the threshold for starting preventative treatment for cardiovascular disease be halved from a 20-percent risk over 10 years, to a 10-percent risk.
