The British Medical Journal has published the results of a meta-analysis into the efficacy of different classes of blood pressure lowering drugs in preventing coronary heart disease (CHD) and stroke. Additionally, this study aimed to determine who should be treated.
The analysis included data from 147 randomised controlled trials and 464,000 individual participants. The data were analysed by categorising patient data into one of three groups: no history of vascular disease, a history of CHD, or a history of stroke.
It was found that a blood pressure reduction of 10mmHg for systolic blood pressure and 5mmHg for diastolic blood pressure resulted in a 22% reduction in CHD events (95% confidence interval: 17% - 27%) and a 41% reduction in stroke (33% - 48%). The five main classes of drugs (thiazides, beta-blockers, ACE inhibitors, angiotensin receptor blockers and calcium channel blockers) were all equally effective in reducing CHD events while calcium channel blockers were slightly more effective in reducing strokes. Reductions in CHD and stroke appear to persist with reductions as low as blood pressures of 110/70mmHg; below this level there are insufficient data to draw conclusions.
The authors conclude that, "consideration should be given to replacing current policies that focus on routinely measuring blood pressure with policies that focus on routinely lowering blood pressure". This assertion has been reported in the general media (BBC).
Action: Clinicians should be aware of this meta-analysis. Any changes in national policy need to be made after consideration of the economic impact and any potential safety issues that may arise from greater usage of antihypertensives. As such, clinicians should continue to implement current guidelines.
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