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Evidence Summary
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Got It, Hide thisBlood pressure–lowering drugs reduce cardiovascular events most in people with the highest initial risk
Sundstrom J, Arima H, Woodward M, et al. Blood pressure-lowering treatment based on cardiovascular risk: a meta-analysis of individual patient data. Lancet. 2014;384:591-8.
Review question
Do drugs that are used to treat high blood pressure reduce major cardiovascular events (e.g., stroke, heart attack, coronary heart disease) more in people who initially have a higher vs lower risk of those events?
Background
High blood pressure is usually defined as having a systolic blood pressure of 140 mm Hg or more or a diastolic blood pressure of 90 mm Hg or more. High blood pressure doesn’t always cause symptoms but can, over time, weaken or narrow blood vessels and cause strokes, heart attacks, or other heart problems.
Drugs that lower blood pressure can also reduce risk of cardiovascular events. They may work better in people who are initially at higher risk of cardiovascular events (e.g., older people, smokers, people with a family history of high blood pressure).
How the review was done
The researchers included data from 11 randomized controlled trials involving 51,917 people (average age 65 years, 45% women) in their analysis.
The key features of the trials were:
- drugs were given to lower blood pressure and included angiotensin-converting enzyme inhibitors (e.g., ramipril [Altace®], perindopril [Aceon®], trandolapril [Mavik®]), calcium channel blockers (e.g., amlodipine [Norvasc®, Amvaz®], felodipine [Plendil®]), and diuretics (e.g., indapamide [Lozol®]);
- most drugs were compared with placebo, although some trials compared higher-dose with lower-dose drugs; and
- outcome was major cardiovascular events (any of stroke, coronary heart disease [heart attack], heart failure [problems with the heart’s ability to pump blood], or other cardiovascular events).
What the researchers found
Compared with control (placebo or lower-dose drugs), blood pressure–lowering drugs:
- reduced major cardiovascular events regardless of initial risk level; and
- had a greater effect in people with the highest initial risk.
Conclusions
Blood pressure–lowering drugs reduce major cardiovascular events in people with different initial levels of risk. They provide the most benefit in people with the highest initial risk.
Blood pressure (BP)–lowering drugs vs control* in people with different levels of initial risk for major cardiovascular (CV) events†
| Initial risk for CV event over 5 years | Number of people in risk group | Rate of events with BP-lowering drugs | Rate of events with control | Absolute effect of BP-lowering drugs over 5 years‡ |
| < 11% | 24,480 | 3.9% | 4.2% | About 14 fewer people out of 1000 had a major CV event |
| 11% to 15% | 12,544 | 7.8% | 8.7% | About 20 fewer people out of 1000 had a major CV event |
| 15% to 21% | 8,287 | 12% | 13% | About 24 fewer people out of 1000 had a major CV event |
| > 21% | 5,606 | 17% | 20% | About 38 fewer people out of 1000 had a major CV event |
Related Topics
Glossary
A group of medications that control the hormone system that regulates blood pressure and water balance in the body.
A group of medications that reduce the stiffness of large blood vessels and therefore lower (systolic) blood pressure.
Also known as coronary artery disease (CAD), is a narrowing of the blood vessels (coronary arteries) that supply oxygen and blood to the heart.
The lower number in a blood pressure reading. It is the pressure when the heart rests between beats.
Medications that increase the elimination of water from the body. Used to treat heart failure, high blood pressure, and some kidney diseases.
A harmless, inactive, and simulated treatment.
Studies where people are assigned to one of the treatments purely by chance.
The higher number in a blood pressure reading. It is the pressure in the arteries when the heart beats.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.
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