Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.

Abstract (PubMed)

BACKGROUND: The benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established. However, the extent to which these effects differ by baseline blood pressure, presence of comorbidities, or drug class is less clear. METHOD: For this systematic review and meta-analysis, we searched MEDLINE for large-scale blood pressure lowering trials, published between Jan 1, 1966, and July 7, 2015. All randomised controlled trials of blood pressure lowering treatment were included. We tabulated meta-analyses of 10 mmHg reductions in systolic blood pressure, and meta-regression analyses of the effects of blood pressure lowering according to baseline systolic blood pressure and the presence of coronary heart disease, stroke, diabetes, heart failure, and chronic kidney disease. RESULTS: We identified 123 studies with 613,815 participants. Meta-regression analyses showed relative risk reductions proportional to the magnitude of blood pressure reductions achieved. Every 10 mmHg reduction in systolic blood pressure significantly reduced the risk of major cardiovascular disease events (RR 0.80, 95% CI 0.77-0.83), coronary heart disease (0.83, 0.78-0.88), stroke (0.73, 0.68-0.77), and heart failure (0.72, 0.67-0.78), which, in the populations studied, led to a significant 13% reduction in all-cause mortality (0.87, 0.84-0.91). INTERPRETATION: Blood pressure lowering significantly reduces vascular risk across various baseline blood pressure levels and comorbidities. Our results provide strong support for lowering blood pressure to systolic blood pressures less than 130 mmHg and providing blood pressure lowering treatment to individuals with a history of cardiovascular disease, coronary heart disease, stroke, diabetes, heart failure, and chronic kidney disease. FUNDING: National Institute for Health Research and Oxford Martin School.