Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: A meta-analysis of...

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Trials

Background:

• Traditional blood pressure treatment guidelines focus on thresholds.
• Cardiovascular risk prediction is increasingly advocated for guiding treatment decisions.
• This study compares risk-based versus threshold-based blood pressure management strategies.

Purpose of the Study:

• To compare the effectiveness of a blood pressure-lowering strategy based on predicted cardiovascular risk versus one based on systolic blood pressure (SBP) level.
• To determine which strategy prevents more cardiovascular disease (CVD) events per person treated.

Main Methods:

• Utilized individual participant data from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) trials (1995-2013).
• Estimated 5-year CVD event risk using a multivariable Weibull model.
• Compared outcomes of risk-based versus SBP-based treatment strategies across various thresholds.

Main Results:

• The cardiovascular risk strategy avoided more CVD events per person treated compared to the SBP strategy (AUC 0.71 vs. 0.54).
• A risk-based strategy required treating fewer individuals to prevent the same number of events compared to SBP thresholds (e.g., ≥150 mmHg).
• The risk-based strategy showed greater event prevention for the same number of treated individuals compared to SBP thresholds.

Conclusions:

• Blood pressure treatment guided by predicted cardiovascular risk is more effective than using blood pressure levels alone.
• Results support using cardiovascular risk assessment for blood pressure treatment decisions in moderate- to high-risk individuals.
• This approach is particularly beneficial for primary CVD prevention.