“Our results,” Dr. Malcolm R. Law and colleagues conclude, “indicate the importance of lowering blood pressure in everyone over a certain age, rather than measuring it in everyone and treating it in some.”
To investigate the use of blood pressure-lowering drugs in preventing heart disease, the investigators analyzed data from 147 randomized trials identified through a search of Medline from 1966 to 2007. A total of 464,000 subjects were included in the analysis, according to a report in the May 20th Online First issue of the British Medical Journal.
The investigators found that for a given reduction in blood pressure, the various classes of antihypertensive agents had similar effects in preventing coronary heart disease events and stroke. There were two notable exceptions, however: Beta blockers were better than other antihypertensive classes at preventing events when given shortly after myocardial infarction, and calcium channel blockers were slightly more effective than other drugs in preventing stroke.
Antihypertensive drugs reduced the risk of cardiovascular events to a similar extent regardless of the initial blood pressure or the presence or absence of preexisting cardiovascular disease, the analysis showed.
Based on the findings, Dr. Law and colleagues believe that guidelines on the use of blood pressure-lowering agents can be simplified so that individuals with all levels of blood pressure are offered these medications.
“The place of the sphygmomanometer in the doctor’s office for monitoring blood pressuring lowering treatment no longer seems secure — it may perhaps be replaced by periodic enquiry about side effects as treatment choices become determined by tolerability rather than by algorithm,” Dr. Richard J. McManus, from the University of Birmingham, UK, and Dr. Jonathan Mant, from the University of Cambridge, UK, comment in an editorial published with the study.
BMJ Online First 2009.