Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Further Benefits of Blood Pressure Lowering

Prevention of CVD and death

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Blood pressure lowering significantly reduced vascular risk across various baseline blood pressure (BP) levels and comorbidities in a meta-analysis of 613,815 patients. These results support lowering blood pressure to systolic blood pressures <130 mmHg while providing BP lowering treatment to individuals with a history of cardiovascular disease, coronary heart disease, stroke, diabetes, heart failure, and chronic kidney disease. Results from the study included:

• Every 10 mmHg reduction in systolic BP significantly reduced the risk of major cardiovascular disease events by 20% (RR=0.80), coronary heart disease (RR=0.83), stroke (RR=0.73), and heart failure (RR=0.72), which led to a significant 13% reduction in all-cause mortality (RR=0.87).

• The effect on renal failure was not significant (RR=0.95).

• Similar proportional risk reductions were noted in trials with higher mean baseline systolic BP and trials with lower mean baseline systolic BP.

• There was no clear evidence that proportional risk reductions in major CVD differed by baseline disease history. Diabetes and chronic kidney disease did have smaller, but still significant risk reductions.

Citation: Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. [Published online ahead of print December 23, 2015]. Lancet. doi: http://dx.doi.org/10.1016/S0140-6736(15)01225-8.

Commentary: The SPRINT trial recently showed that in a high-risk population, a target systolic blood pressure of less than 120 mmHg achieved greater reductions in cardiovascular end-points than a systolic goal of <140 mmHg.1 This study adds to the evidence from SPRINT, that we may consider a blood pressure lower than the current standard of 140 mmHg. In addition, this study shows efficacy across all major risk groups and that the CV improvement with treatment holds true regardless of baseline blood pressure. The study also showed that beta-blockers did not work as well as other drugs to prevent major cardiovascular disease events, stroke, and renal failure. In addition, the study suggested that we might be able to tailor pharmacologic treatment for some patients based on the highest risk event we are trying to avoid. Calcium channel blockers were better than other medications for the prevention of stroke. For heart failure, calcium channel blockers were not as good and diuretics were better than other drug classes. —Neil Skolnik, MD
1. Wright JTJ, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015; 373: 2103–16.

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