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A change in paradigm: lowering blood pressure in everyone over a certain age

Malcolm Law1

  • 1Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK. m.r.law@qmul.ac.uk

Annals of Medicine
|June 21, 2012
PubMed

Insights

The link between blood pressure and cardiovascular disease risk is continuous, not a simple division. Blood pressure-lowering treatments benefit individuals proportionally to their existing risk, regardless of whether they are hypertensive or normotensive.

Area of Science:

  • Cardiovascular Medicine
  • Public Health
  • Clinical Pharmacology

Background:

  • Traditional classification of individuals into 'hypertensives' and 'normotensives' is clinically problematic.
  • The relationship between blood pressure and cardiovascular disease risk is continuous across the population.

Purpose of the Study:

  • To evaluate the continuous relationship between blood pressure and cardiovascular disease risk.
  • To assess the efficacy of blood pressure-lowering drugs across different blood pressure ranges.
  • To inform treatment decisions based on absolute cardiovascular risk.

Main Methods:

  • Analysis of the Prospective Studies Collaboration data for dose-response relationships.
  • Meta-analysis of randomized controlled trials on blood pressure-lowering medications.
  • Examination of risk reduction in normotensive individuals.

Main Results:

  • A continuous, linear dose-response relationship exists between blood pressure and cardiovascular disease risk down to 115/75 mmHg.
  • Blood pressure-lowering drugs provide similar proportional risk reduction for coronary heart disease and stroke across various pre-treatment levels (down to 110/70 mmHg).
  • Statistically significant risk reduction is observed in normotensive individuals without prior vascular disease.

Conclusions:

  • Treatment decisions for blood pressure should be based on an individual's overall absolute cardiovascular risk, not solely on diagnostic categories.
  • The proportional benefit of blood pressure lowering is consistent across the blood pressure spectrum.
  • In primary prevention, using age as a proxy for risk may be simpler than absolute risk assessment, but absolute risk is more accurate.

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