New research has found that even people with normal blood pressure and no history of heart disease may benefit from taking antihypertensive drugs.
- New research has found that even people with normal blood pressure and no history of heart disease may benefit from taking antihypertensive drugs.
- The researchers say the findings suggest that blood pressure-lowering drugs can help prevent heart disease and stroke in some people at risk of heart events.
- Cardiologists say more research is needed.
New research has found that people with normal blood pressure and no history of heart disease may benefit from taking antihypertensive drugs.
This meta-analysis, published May 1 in The Lancet, found that for every 5 mm Hg reduction in systolic blood pressure, the risk of heart attack or stroke is reduced by about 10 percent, even in people without a history of heart disease.
The researchers say the findings suggest that medications that lower blood pressure can help prevent heart disease and stroke in some people at risk of heart events.
Cardiologists say the findings underscore the need to further evaluate whether and how some people with the normal blood pressure but at risk for cardiovascular disease benefit from taking blood pressure-lowering medications.
Traditionally, blood pressure-lowering drugs have only been used in people with abnormal blood pressure levels.
More research needs to determine which risk factors — such as those with diabetes, smokers, and people with a family history of heart disease — may indicate the use of antihypertensive drugs.
"Defining these increased risks remains important and requires patients and physicians to think carefully before starting treatment based on this meta-analysis," said Dr. Steven Schiff, cardiologist and medical director of invasive cardiology and head of cardiology services at MemorialCare Heart & Vascular, said the Institute at an orange coastal medical center in Fangquan Valley, California.
The medication was helpful for all participants, regardless of blood pressure
The researchers looked at data from 48 clinical trials, including 344,716 participants.
Participants have divided into two groups: 157,728 participants had a history of heart disease (called the secondary prevention group) and 186,988 participants had no history of heart disease (called the primary prevention group).
The two groups were then further divided into seven subgroups based on systolic blood pressure levels (the highest number), ranging from less than 120 mmHg to more than 170 mmHg.
Approximately 20% of patients with previous heart disease and 8% of patients without a history of heart disease have normal or high systolic blood pressure.
During a 4-year follow-up period, 42,324 people experienced cardiovascular events, including heart attacks, strokes, heart failure, or heart-related deaths.
Researchers have found that every 5 mm Hg reduction in systolic blood pressure results in:
- 10% lower risk of cardiovascular disease
- 13% reduction in stroke risk
- 13% lower risk of heart failure
- 8% reduction in ischemic heart disease
- 5% reduction in cardiovascular disease
The effect was consistent between participants with previous heart disease and those who did not have heart disease.
"In the primary and secondary prevention groups, as well as in all baseline blood pressures, the risk of vascular events decreased consistently as blood pressure decreased," said Dr. Judith Meadows, associate professor of medicine in the Department of Cardiovascular Medicine at Yale University. Drugs.
The researchers say the findings suggest that blood pressure itself should not indicate whether someone is suitable for antihypertensive medications, and that other risk factors must also be considered.
Should people take antihypertensive drugs as a preventive tool?
Currently, people with normal blood pressure levels do not routinely prescribe blood pressure medications.
"The current standard is to give antihypertensive drugs to patients with elevated blood pressure (or even high normal blood pressure), but not for patients with normal blood pressure," Schiff said.
Dr. Joseph Alpert, a medical professor, and cardiologist at the University of Arizona School of Medicine-Tucson and Saver Heart Center said some people with mildly elevated blood pressure take blood pressure-lowering medications.
"Studies have shown that, for example, if we lower their blood pressure to a new lower level, they have a lower risk of stroke," Alpert said.
According to Meadows, the definition of normal blood pressure continues to be controversial in the medical community.
"Over the past 20 years, the definition of normal blood pressure, as well as the definition of hypertension, has changed with a significant increase in the hypertension threshold," Meadows said.
The new study suggests that more people can benefit from blood pressure medications based on their overall cardiovascular risk.
But as Schiff points out, the study didn't shed light on these risk factors.
"The abstract doesn't exactly define who these people are, and it's hard to justify having everyone take BP medications," Schiff said.
More research is needed to determine which people with normal blood pressure can benefit from taking blood pressure-lowering medications.
"Patients with diabetes and high cholesterol or ct scan-positive coronary artery calcifications, patients with a family history, and smokers may be considered at increased risk, even if there is no history of elevated blood pressure or previous cardiovascular disease," Schiff said.
Do the benefits offset the side effects?
Meadows says most blood pressure-lowering drugs are well tolerated and have no side effects.
But some people who take antihypertensive drugs experience dizziness or fainting, Schiff said. Others develop coughs that may not be predictable but reversible.
In some cases, Schiff says, side effects may counteract the benefits. The doctor can lower the dose or prescribe alternative therapy.
"There are many different families of antihypertensive drugs, so patients who experience side effects can use alternative drugs that may have different side effects," Meadows said.
According to Alpert, doctors need to be careful when treating people with normal blood pressure and not to lower blood pressure excessively.
All in all, experts say the findings are interesting but need to be carefully and intentionally applied to the real world.
Meadows says preventing heart disease requires an integrated approach that takes into account a person's risk factors, personal beliefs, and overall health.
"While this [new study] provides a strong argument that lowering blood pressure may help improve cardiac risk regardless of a patient's baseline blood pressure, specialized trials should be designed to address the issue of lower blood pressure," Meadows said, all within the normal range.
Conclusion
New research has found that even people with normal blood pressure and no history of heart disease may benefit from taking antihypertensive drugs.
The researchers say the findings suggest that blood pressure-lowering medications can help prevent heart disease and stroke in some people at risk of heart events.
Cardiologists say more research is needed to determine which risk factors suggest a person may benefit from taking antihypertensive drugs.