BLOOD PRESSURE pills can prevent strokes and heart attacks even in healthy adults, according to the largest ever analysis into the issue.
The study of 345,000 people drawn from 48 randomised clinical trials found that blood pressure-lowering medication reduced the risk of a serious cardiovascular event by around 10 per cent even in adults with normal blood pressure and no history of a heart attack or stroke.
The findings, published today in the Lancet, have led to calls from the researchers for international guidelines to be changed so that doctors can consider prescribing the drugs to anyone at increased risk of cardiovascular disease regardless of their blood pressure.
Currently the medication is limited to individuals whose blood pressure is high – usually above 140/90 mmHg.
Kazem Rahimi, a professor of cardiovascular medicine and population health at Oxford University and lead author for the study, said: “Our findings are of great importance to the debate concerning blood pressure treatment.
“This new and best available evidence tells us that decisions to prescribe blood pressure medication should not be based simply on a prior diagnosis of cardiovascular disease or an individual’s blood pressure level.
“Instead, medication should be viewed as an effective tool for preventing cardiovascular disease in people at increased risk of developing heart disease or stroke. Clinical guidelines should be changed to reflect these findings.”
He stressed that their conclusions did not mean that the drugs should be prescribed universally, however.
“The decision will depend on an individual’s risk factors for developing cardiovascular disease, the potential for side effects and patient choice,” said Prof Rahimi.
Heart disease and stroke, linked to high blood pressure, are among the leading causes of death in Scotland and while the morality rate from cardiovascular disease has improved substantially in recent decades it still remains around 22 per cent higher than the UK average.
There have been more than 20,000 cardiovascular deaths in Scotland since the start of 2020.
It is widely accepted that blood pressure medication protects people who have had a prior heart attack or stroke from having a second, but there has been no clear guidance on the use of these drugs in people with normal or mildly elevated blood pressure.
The Lancet study divided participants into two groups: 157,728 people with a prior diagnosis of cardiovascular disease and 186,988 without cardiovascular disease.
The average age was 65.
The randomised trials from which the data was drawn covered various intervention types, such as drug versus placebo, drug versus drug, or more and less intensive treatments.
Each group was then divided into seven subgroups based on their starting systolic blood pressure, from less than 120 to 170 and above.
Over an average of four years follow-up, 42,324 participants had at least one major cardiovascular event, such as a heart attack, stroke, heart failure, or death from cardiovascular disease.
For every five units – or mmHg – that participants’ systolic blood pressure was reduced by, the risk of developing major cardiovascular disease fell by around 10% , stroke by 13%, heart failure by 13%, ischaemic heart disease by 8%, and death from cardiovascular disease by 5%.
The beneficial effects of the treatment did not differ based on prior history of cardiovascular disease or the level of blood pressure at study entry.
Co-author Zeinab Bidel said: “It is important that people are considered for blood pressure-lowering treatment based on their cardiovascular risk, rather than focusing on blood pressure itself as a qualifying factor for or target of treatment.
“We must provide well-rounded guidelines to lower risks for cardiovascular disease that include exercise, nutrition, smoking cessation, and – where appropriate – medication.”