Accepted Abstracts: J Clin Exp Cardiolog
Systematic review of evidence from randomised controlled trials of blood pressure lowering drugs and from cohort studies shows that a blood pressure reduction of 10mmHg systolic/5mmhg diastolic reduces risk of CHD events by an estimated 25% and stroke by 36%. These risk reductions are attributable to blood pressure lowering; the drugs have no major pleiotropic effects. The proportional risk reductions are similar in primary and secondary prevention, and apply irrespective of the level of pre-treatment blood pressure (down to 110/70). The 5 major classes of blood pressure lowering drugs reduce blood pressure and risk of CVD events to a similar extent, but using the drugs in low-dose combinations minimises adverse effects: 3 drugs together in half dose cause side effects in an estimated 5% of people only, and reduce risk of CHD by 46% and stroke by 62%. Blood pressure guidelines need to move away from the traditional ?hypertensive/normotensive? concept; the decision to take drugs to lower blood pressure lowering drugs should be based on overall cardiovascular risk, not level of blood pressure.