The lower BP achieved, the greater the reduction in heart attacks and strokes, finds study
Hundreds of millions of people worldwide could benefit from more intensive treatment to lower blood pressure, according to new research from The George Institute for Global Health at the University of Oxford.
Principal Director, Professor Stephen MacMahon, said the research, which was published in The Lancet, showed that the lower the level of blood pressure (BP) achieved, the greater the reduction in heart attacks and strokes.
“We have previously shown that lowering BP below 140 mm Hg is of great benefit to people with diabetes and people who have had a previous stroke, but this new finding indicates that the benefits are much wider. By setting blood pressure targets too high, we have sharply limited the benefits that could have been achieved with BP lowering drugs over the past few decades. We urgently need new recommendations encouraging both doctors and patients to aim for much lower levels of BP than were previously thought necessary,” Prof MacMahon said.
The study, Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis found:
- Patients receiving more intensive treatment had their blood pressure lowered to 133 mm Hg, compared to 140 mm Hg among those receiving less intensive treatment
- This produced a 13 per cent reduction in heart attacks and a 22 per cent reduction in strokes
- Even patients who had a blood pressure less than 140 mm Hg to begin with, benefitted from treatment
These findings are supported by a second study in the New England Journal of Medicine (NEJM), which also shows that setting lower BP targets reduces the risk of stroke, heart attack and death.
Executive Director for the Institute, Professor Vlado Perkovic was asked to write the editorial for the research and said it was a game changer.
“There are very few treatments proven to reduce the risk of death among mostly healthy people, but lowering blood pressure to low target levels is now one of them. The Systolic Blood Pressure Intervention (SPRINT) trial enrolled more than 9,000 people with blood pressure levels above 130 mm Hg who were at high risk of heart disease and stroke. It compared standard treatment goals of 140 mm Hg or less with more aggressive goals of 120 mm Hg or less. People treated to the lower target had their risks of major complications, including death, reduced by a quarter,” Prof Perkovic said.
Professor Perkovic said the research changes everything when it comes to understanding and treating high blood pressure.
“Now, with this research, more people can be treated appropriately with lifestyle modification, and if they are at high risk, blood pressure lowering medicines, achieving a big reduction in their risk of death. Globally, there are several billion people with blood pressure levels that are too high, which underscores the need for better prevention, like reducing salt intake. These latest results confirm that medical treatment for those at high risk of stroke or heart attack needs to be more intensive, and when this is achieved the benefits will be very worthwhile,” he said.
Anthony Rodgers, Professor of Global Health at the Institute, said it had taken far too long to get to this point.
“The George Institute for Global Health has been recommending these changes for many years. Many people have said the evidence has been ‘hiding in plain sight’ for a while now – but this will really be a tipping point. The big challenge now is implementing these effective treatments more widely among people at high risk,” said Prof Rodgers.
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