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BP targets should be lower

Clinical evidence now offers “strong support” to reduce systolic blood pressure to less than 130mmHg, according to a new systematic review and meta-analysis of 123 studies involving 613,815 patients.

Every 10mmHg reduction in systolic blood pressure significantly reduced the risk of heart failure by 28 per cent, stroke by 27 per cent, major cardiovascular disease (CVD) events by 20 per cent, coronary heart disease by 17 per cent and all-cause mortality by 13 per cent. The effect on renal failure was not significant.

The authors suggest that lowering blood pressure to below targets in current guidelines (systolic blood pressure of less than 140mmHg) will further reduce CVD risk. As no threshold emerged, the authors suggest that healthcare professionals should base blood pressure lowering “on an individual’s potential net benefit” rather than attaining a specific target.

More targeted drug use needed to lower BP

 

Similar risk reductions emerged irrespective of mean baseline systolic blood pressure and, in general, baseline medical history. The benefit on major CVD events was less marked in people with than without diabetes (12 and 25 per cent reductions for each 10mmHg reduction in systolic blood pressure).

The benefits were greater in people without than with chronic kidney disease for major CVD events (32 and 16 per cent reductions) and heart failure (52 and 5 per cent reductions, the latter differences nonsignificant). The results’ “broad consistency” could help simplify clinical guidelines.

According to the analysis, beta-blockers seemed to be less effective than other drugs for preventing major CVD events, stroke and renal failure. Calcium channel blockers were superior for stroke prevention, but inferior against heart failure.

Diuretics were superior for heart failure prevention. The authors say the findings support “more targeted drug use” in patients at high risk of specific outcomes.

Lancet doi: 10.1016/ S0140-6736(15)01225-8

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