Using blood pressure medication to prevent heart attacks and strokes
Blood pressure-lowering drugs are even more beneficial than previously thought.
The Blood Pressure Lowering Treatment Trialists Collaboration (BPLTTC) study seems to confirm that blood pressure medication can prevent heart attacks and strokes. The conclusions from this study indicate that greater drops in blood pressure with medication lead to greater reductions in the risk of heart attacks and strokes, regardless of the starting blood pressure level.
In another study, results show that lowering blood pressure by using antihypertensive medication in healthy people (60 years of age or older) with increased blood pressure decreases the occurrence of death, heart attacks and strokes. The benefit was similar if the upper (systolic) and lower (diastolic) blood pressure numbers were elevated or if only the upper blood pressure number was elevated. The magnitude of benefit in cardiovascular mortality and morbidity observed was greater among those 60–79 years of age than for those 80 year of age or older.
There was previously the controversy about whether pharmacological blood pressure lowering is equally beneficial in people with versus without a prior heart attack or stroke, and when blood pressure is below the threshold for hypertension (typically 140/90 mmHg). In fact, the evidence from previous studies was inconclusive, leading to contradictory treatment recommendations around the world.
The BPLTTC study brought the answer to these questions. The BPLTTC trial was the largest — and most detailed — study ever conducted to examine these questions. The researchers combined data on individuals who had participated in a randomized clinical trial and conducted a meta-analysis. The study included 348,854 participants from 48 trials. The participants were divided into two groups: those with a prior diagnosis of cardiovascular disease and those without. Each group was divided into seven subgroups based on systolic blood pressure at study entry (less than 120, 120–129, 130–139, 140–149, 150–159, 160–169, 170 and above mmHg).
Over an average of four years of follow-up, each 5mmHg reduction in systolic blood pressure lowered the relative risk of major cardiovascular events by about 10%. The risks for stroke, ischemic heart disease, heart failure, and death from cardiovascular disease were reduced by 13%, 7% and 14% and 5%, respectively.
Neither the presence of cardiovascular disease, nor the level of blood pressure at study entry modified the effect of treatment.
This means the decision to prescribe blood pressure medication should not be based simply on a prior diagnosis of cardiovascular disease or an individual’s current blood pressure. Rather, blood pressure medication should be viewed as an effective tool for reducing cardiovascular risk when an individual’s probability of having a heart attack or stroke is elevated.
Remember: Periodic medical evaluation can protect us from this silent enemy, the stroke.
References
- https://www.acc.org/latest-in-cardiology/articles/2020/08/29/02/40/mon-1030am-bplttc-bp-lowering-for-prevention-cv-events-esc-2020
- Musini, Vijaya M., et al. “Pharmacotherapy for hypertension in adults 60 years or older.” Cochrane Database of Systematic Reviews 6 (2019).
