Small BP Reduction, Sizable Impact on CV Event Reduction

A 5 mm Hg reduction in systolic blood pressure (BP) reduced the risk of major cardiovascular disease events by about 10%, irrespective of previous diagnoses of cardiovascular disease, even at normal or high-normal BP values, according to a meta-analysis published in The Lancet.

Researchers evaluated individual participant-level data from 48 randomized trials of BP-lowering medications vs. placebo or other classes of BP-lowering medications, or between more vs. less intensive treatment regimens. Trials exclusively done in heart failure or short-term interventions in acute settings were excluded.

Among the 344,716 participants in the meta-analysis, pre-randomization mean BP was 146/84 mm Hg in participants with previous cardiovascular disease (46%) and 157/89 mm Hg in those without (54%).

After a median 4.15 years, 42,324 participants (12.3%) had at least one major cardiovascular event (stroke 4.0%, ischemic heart disease 5.6%, congestive heart failure 2.4%). In participants without cardiovascular disease at baseline, the incidence rate for developing a major cardiovascular event in the intervention and comparator groups was 25.9 and 31.9 per 1,000 person-years. In those with cardiovascular disease at baseline, these rates were 36.0 and 39.7.

Hazard ratios associated with a reduction of systolic BP by 5 mm Hg for a major cardiovascular event were 0.91 and 0.89 for participants without and with cardiovascular disease at baseline.

These findings suggest a fixed degree of pharmacological BP lowering is similarly effective for primary and secondary prevention of major cardiovascular disease, even at BP levels currently not considered for treatment.

Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet 2021;387:1625-36.

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