Intensive blood pressure lowering reduces heart attacks

One quarter of the world’s adult population suffers from hypertension, and although it has no obvious symptoms, it can lead to heart attacks, stroke, kidney failure and blindness. Despite this, there has been great uncertainty as to how intensively blood pressure should be lowered to obtain maximal benefit and minimize risks.

Researchers from Australia, China, Japan, and the USA, led by Professor Vlado Perkovic from The George Institute for Global Health in Sydney and Dr Jicheng Lv from the Peking University First Hospital, have reported new findings that suggest intensive blood pressure lowering regimens, which use a combination of drugs to reduce blood pressure more intensively than usual, are effective at preventing more heart attacks, strokes and kidney failure than less intensive treatment.

Professor Perkovic said the systematic review included studies that involved 37,000 participants and compared intensive blood pressure treatment against standard blood pressure lowering regimens.

“Compared to standard blood pressure lowering strategies, more intensive strategies reduced the risk of major cardiovascular events by 11%; intensive blood pressure lowering strategies reduced the risk of heart attack by 13%; the risk of stroke by 24%; the risk of end-stage kidney disease by 11%; and the risk of protein in the urine (a sign of kidney damage) by 10%,” Professor Perkovic said.

“Overall, intensive strategies reduced blood pressure by 7.5/4.5 mmHg more than the less intensive strategies. The benefits were similar at different blood pressure levels, including in trials that aimed for blood pressures below currently recommended targets (130 mmHg systolic or 80 mmHg diastolic)

“We calculated that for every thousand hypertensive patients at high risk of cardiovascular disease, more intensive blood pressure lowering regimens could prevent two of the 20 cardiovascular events predicted in these patients every year.”

Professor Perkovic said that few large-scale randomized trials had been done to evaluate the effects of intensive blood pressure lowering amongst patients with uncomplicated hypertension.

“Further trials are required to more clearly define the risks and benefits of blood pressure targets below those currently recommended, given the benefits suggested by the currently available data,” he said.

Full details of the study and results were published this week in PLoS Medicine.