ESC 2020 — Antihypertensives reduce risk for cardiovascular events across BP levels


  • Pavankumar Kamat
  • Conference Reports
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Takeaway

  • Lowering blood pressure (BP) with antihypertensive drugs reduces the risk for future cardiovascular events, even in individuals with normal or only mildly elevated BP.

Why this matters

  • Currently, hypertension guidelines do recommend an assessment of overall cardiovascular risk but only when BP readings have reached a certain threshold.

Study design

  • BPLTTC: a meta-analysis of 48 randomized controlled trials on antihypertensive treatment involving 348,854 participants.
  • Participants were divided into 2 groups, one with a prior diagnosis of cardiovascular disease (CVD) and the other without. Each group was then further divided into 7 subgroups as per systolic BP.
  • Primary outcome was major cardiovascular events, including fatal/non-fatal stroke, fatal/non-fatal myocardial infarction or ischemic heart disease or heart failure resulting in death or hospitalisation.
  • Funding: British Heart Foundation; National Institute for Health Research Oxford Biomedical Research Centre; Oxford Martin School; UK Research and Innovation.

Key results

  • Over 4 years of follow-up, each 5 mmHg reduction in systolic BP was associated with a 10% reduction in the relative risk for major cardiovascular events (HR, 0.90; 95% CI, 0.88-0.92).
  • For each 5 mmHg reduction in systolic BP, the risk reduction by CVD status at baseline was as follows:
    • CVD at baseline: 11% (HR, 0.89; 95% CI, 0.86-0.92); and
    • No CVD at baseline: 9% (HR, 0.91; 95% CI, 0.89-0.94).
  • For each 5 mmHg reduction in systolic BP, the risk reduction for individual outcomes was as follows:
    • Stroke: 13% (HR, 0.87; 95% CI, 0.84-0.90);
    • Heart failure: 14% (HR, 0.86; 95% CI, 0.82-0.91);
    • Ischemic heart disease: 7% (HR, 0.93; 95% CI, 0.90-0.96); and
    • Cardiovascular death: 5% (HR, 0.95; 95% CI, 0.91-0.99).
  • There was no evidence that proportional effects varied by baseline BP readings, down to the lowest systolic BP category of

Limitations

  • Parameters influencing shared decision-making for antihypertensive therapy such as absolute treatment effects, side effects and adherence to treatment were not assessed.