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 Researchers examined data from 74 previously published clinical
trials that randomly selected a total of more than 306,000 people to
take blood pressure drugs or placebo.
Treatment to lower blood pressure only appeared to help prevent
heart disease and boost survival odds for people who started out
with systolic blood pressure above 140 mmHg.
The exception was people with heart disease who took medication to
reduce blood pressure below 140 mmHg, who did have a lower risk of
cardiovascular events like heart attacks or strokes, the researchers
report online November 13 in JAMA Internal Medicine.
“Our results support a very simple strategy where everyone with a
blood pressure above 140 mmHg should receive treatment, whereas most
people below that level will have no further benefit from additional
medications,” said study co-author Dr. Mattias Brunstrom of Umea
University in Sweden.
“Patients with previous heart disease may benefit from lower blood
pressure goals, and an individual goal should be established
together with the patient´s physician,” Brunstrom said by email.
Setting the right goal for blood pressure has been a matter of
intense debate in the medical community in recent years because
research to date has offered a mixed picture of which patients may
benefit from treatment, Brunstrom added.
Complicating matters, many patients with dangerously high blood
pressure don’t take drugs to treat it or commit to lifestyle changes
that could achieve the same goal like improving their diet and
exercise habits.
New recommendations announced this week at the American Heart
Association conference in Anaheim, California, set a systolic target
of 130 mmHg as a goal for lowering high blood pressure. For decades,
the goal had been 140 mmHg in the U.S., and this is still the target
in Europe. In Canada and Australia, however, the goal is 120 mmHg.
“There is an ongoing controversy about setting strict guidelines
about blood pressure levels and in which setting it is safe or
justified to treat elevated blood pressure,” said Dr. Costantino
Iadecola, director of the Feil Family Brain and Mind Research
Institute at Weill Cornell Medicine in New York.
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The results of the current study suggest that the right blood
pressure goal may not be one size fits all, Iadecola said.
“The message here is that there is no universal number good for
everyone,” added Iadecola, who wasn’t involved in the study.
When people had blood pressure of at least 160 mmHg, medication to
reduce it was associated with a 7% lower risk of death across all of
the studies in the analysis, as well as 22% lower odds of events
like heart attacks and strokes.
Between 140 mmHg and 159 mmHg, the reduction in mortality risk was
similar but there was a smaller 12% decrease in the chances of
cardiovascular events like heart attacks or strokes.
Healthy people didn’t appear to benefit from medication if they
already had blood pressure below 140 mmHg.
But with a history of heart disease and average blood pressure of
138 mmHg, medication was associated with a 10% lower risk of events
like heart attacks and strokes. Medication didn’t appear to
influence survival odds for these people, however.
Because the study only examined lowering blood pressure with
medication, it’s not clear if the results would be the same for
other strategies such as changes in diet and exercise habits.
“We have no reason to think it should be any different with
lifestyle modifications, but the scientific evidence supporting that
lifestyle modifications cause less heart disease and stroke is
weaker,” Brunstrom said.
SOURCE: http://bit.ly/2mnlVpg
JAMA Intern Med 2017.
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