The key role of blood pressure lowering in cardiovascular prevention irrespective of baseline blood pressure and risk profile

Key points

The meta-analysis performed by the Blood Pressure Lowering Treatment Trialists’ Collaboration (BPLTTC)1 was based on individual participant-level data for 344 716 participants from 48 randomized trials of pharmacological blood pressure (BP)-lowering medications vs. placebo or other classes of anti-hypertensive drugs, or between more vs. less intensive treatment regimens.The effects of BP-lowering treatment were stratified according to previous cardiovascular disease (CVD) (with and without previous CVD, 157 728 and 186 988, respectively; mean age at baseline, 65 years in both groups) and systolic BP categories (ranging from <120 to ≥170 mmHg). The primary outcome was a composite of major cardiovascular events (MACEs) consisting of fatal or non-fatal stroke, fatal or non-fatal myocardial infarction (MI) or ischaemic heart disease (IHD), or heart failure (HF) causing death or requiring hospital admission.After a median 4.2-year follow-up, MACEs occurred in 42 324 patients (12.3%), with an event rate of 3.2 in the comparator group vs. 2.6 per 100 person-years in the intervention group of participants without previous CVD, with corresponding figures of 4.0 vs. 3.6 in participants with previous CVD. On average, a 5-mmHg reduction in systolic BP produced a 10% decrease in the risk of MACEs in participants with and without previous CVD. The corresponding proportional risk reductions for stroke, HF, IHD, and cardiovascular death were 13%, 13%, 8%, and 5%, respectively. In stratified analyses, there was no apparent heterogeneity of treatment effects on MACEs by baseline CVD status or systolic BP categories

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