Intensively lowering blood pressure reduces the risk of major cardiovascular events more than standard regimens, the Lancet reports.

The meta-analysis included 19 trials involving 44,989 participants, who experienced 2,496 major cardiovascular events during a mean 3.8 years follow-up. Mean blood pressure was 133/76mmHg and 140/81mmHg with intensive and standard treatment respectively.

Intensive lowering of blood pressure reduced the risk of a composite of myocardial infarction, stroke, heart failure and cardiovascular death by 14 per cent compared to standard treatment. The risk of stroke was reduced by 22 per cent, retinopathy progression by 19 per cent, myocardial infarction by 13 per cent and albuminuria by 10 per cent.

Reductions in the risk of heart failure, end-stage kidney disease, cardiovascular death and total mortality did not reach statistical significance. Intensive treatment consistently reduced major cardiovascular events across patient groups, including those with systolic blood pressure lower than 140mmHg.

Serious adverse events were uncommon. While severe hypotension was almost three times commoner with intensive treatment, the absolute increase was small. “There was no suggestion that these adverse effects would outweigh the benefits of treatment in high-risk patient populations,” the authors conclude.

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