BP Lowering Cuts CVD, Mortality Risks in Some

Primary preventive blood pressure (BP) lowering may help reduce the risks of cardiovascular disease (CVD) and mortality in patients with a systolic BP (SBP) of 140 mmHg or higher, according to a recent systematic review and meta-analysis.

High BP is the most significant risk factor for CVD and mortality around the world. However, the ideal cutoff for treatment of high BP is still unclear.
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For their study, the researchers identified and assessed 306,273 unique participants (1.2 million person-years) enrolled in 74 unique trials. Mean patient age was 63.6 years. Study data were identified via PubMed, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effect. Randomized clinical trials that had at least 1000 patient-years of follow-up and had compared BP-lowering drugs vs placebo or different BP goals were included.

The Cochrane Collaborations assessment tool was used to analyze risk of bias. Using the Knapp-Hartung modification, relative risks (RRs) were pooled in random-effects meta-analyses. Outcomes included all-cause mortality, cardiovascular mortality, major cardiovascular events, coronary heart disease (CHD), stroke, heart failure, and end-stage renal disease.

Results of the study demonstrated that, in primary prevention, the association of BP-lowering treatment with major CV events was contingent on baseline SBP. BP-lowering treatment was found to be associated with a decreased risk of mortality (RR 0.93) and a significant decrease in major CV events (0.78) in patients with baseline SBP 160 mmHg or above. A similar association of BP-lowering treatment with decreased risk of mortality (RR 0.87) was observed in patients with baseline SBP 140 to 159 mmHg. However, its association with major CV events (RR 0.88) was less notable in this population.

The researchers did not find that BP-lowering treatment was associated with mortality (RR 0.98) or major CV events (RR 0.97) in patients with baseline SBP below 140 mmHg. However, they observed that treatment was associated with a decreased risk for major CV events (RR 0.90) but not survival (RR 0.98) in patients with previous coronary heart disease (CHD) and mean baseline SBP of 138 mmHg.

“Primary preventive BP lowering is associated with reduced risk for death and CVD if baseline SBP is 140 mmHg or higher,” the researchers concluded. “At lower BP levels, treatment is not associated with any benefit in primary prevention but might offer additional protection in patients with CHD.”

—Christina Vogt

Reference:

Brunström M, Carlberg B. Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: a systematic review and meta-analysis. JAMA Intern Med. 2018;178(1):28-36. doi:10.1001/jamainternmed.2017.6015.