- New research finds that even people with normal blood pressure and no history of heart disease may benefit from taking blood pressure medications.
- The researchers say the findings suggest blood pressure-lowering drugs can help prevent heart disease and stroke in certain people who are at risk of a cardiac event.
- Cardiologists say more research is needed.
New research finds that people with normal blood pressure and no history of heart disease may benefit from taking blood pressure medications.
The meta-analysis, which published May 1 in The Lancet, found that each 5 mm Hg reduction in systolic blood pressure reduced the risk of heart attack or stroke by about 10 percent, even in people with no history of heart disease.
According to the researchers, the findings suggest pharmacological blood pressure-lowering drugs can help prevent heart disease and stroke in certain people who are at risk of a cardiac event.
Cardiologists say the findings highlight the need to further evaluate if and how some people with normal blood pressure who are at risk for cardiovascular disease may benefit from taking blood pressure-lowering medications.
Traditionally, blood pressure-lowering medications are only prescribed to people with abnormal blood pressure levels.
More studies will need to determine what risk factors — such as people with diabetes, smokers, and those with a family history of heart disease— may indicate the use of blood pressure medications.
“Defining those increased risks remains important and requires careful consideration by patients and doctors before starting treatment based on this meta-analysis,” said Dr. Steven Schiff, a cardiologist and medical director of invasive cardiology and service chief of cardiology for MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, California.
The medications helped all participants, regardless of blood pressure
The researchers looked at data from 48 clinical trials, which included a total of 344,716 participants.
The participants were split into two groups: 157,728 participants had a history of heart disease (called the secondary prevention group) and 186,988 participants had no history of heart disease (called the primary prevention group).
The two groups were then further divided into seven subgroups based on their systolic blood pressure levels (the top number), ranging from less than 120 mm Hg to over 170.
About 20 percent of those with preexisting heart disease and 8 percent of those with no history of heart disease had normal or high-normal systolic blood pressure.
During the 4-year follow-up period, 42,324 people had a cardiovascular event, including heart attack, stroke, heart failure, or cardiac-related death.
The researchers found that each 5 mm Hg reduction in systolic blood pressure led to:
- 10 percent lower risk of cardiovascular disease
- 13 percent lower risk of stroke
- 13 percent lower risk of heart failure
- 8 percent decrease in ischemic heart disease
- 5 percent decrease in cardiovascular disease
The effects were consistent among participants who had previous heart disease and those who did not.
“Across primary and secondary prevention groups and across all baseline blood pressures, there was a consistent risk reduction of vascular events with blood pressure lowering,” said Dr. Judith Meadows, an associate professor of medicine in the section of cardiovascular medicine at Yale School of Medicine.
The researchers say the findings suggest that blood pressure alone should not inform whether someone is a candidate for blood pressure-lowering medications, and that other risk factors must be considered.
Should people take blood pressure medications as a preventive tool?
Currently, blood pressure medications aren't routinely prescribed to people with normal blood pressure levels.
“The current standards are to give BP medications to patients with elevated BP (or even high-normal BP), but not for patients with normal BPs,” Schiff said.
Dr. Joseph Alpert, a professor of medicine and a cardiologist at the University of Arizona College of Medicine – Tucson and Sarver Heart Center, said some people with mildly elevated blood pressure levels are given blood pressure-lowering medications.
“Studies show that they have lower risk for stroke, for example, if we get their BP down to the new lower levels of BP,” Alpert said.
According to Meadows, the definition of normal blood pressure continues to be debated in the medical community.
“Over the past 2 decades, the definition of normal blood pressure, and thus hypertension, has shifted with a notable intensification of the threshold of hypertension,” Meadows said.
This new study suggests that more people could benefit from blood pressure medications based on their overall cardiovascular risk.
But as Schiff pointed out, the study doesn’t clarify those risk factors.
“The summaries do not define exactly who those people are, and it would be hard to justify putting everyone on BP medications,” Schiff said.
More research is needed to determine which people with normal blood pressure may benefit from taking blood pressure-lowering medications.
“Diabetes and high cholesterol patients or patients with positive coronary calcification on a CT scan, patients with a family history, and smokers might be considered at increased risk, even without elevated BP or prior history of cardiovascular disease,” Schiff said.
Do the benefits offset the side effects?
Most blood pressure-lowering medications are well tolerated and come with no side effects, according to Meadows.
But some people who take blood pressure medications experience dizziness or fainting, said Schiff. Others develop a cough that may be unpredictable but reversible.
In some cases, the side effects may offset the benefits, said Schiff. Doctors can lower the doses or prescribe alternative therapies.
“There are a number of different families of antihypertensive medications, such that patients that experience side effects have alternative medications that may offer a different side effect profile,” Meadows said.
According to Alpert, doctors need to be careful when treating people with normal blood pressure to not lower their blood pressure too drastically.
All in all, experts say the findings are interesting but need to be carefully and intentionally applied to the real world.
Prevention of heart disease requires a holistic approach that considers a person's risk factors, personal beliefs, and overall health, said Meadows.
“While this [new study] provides a strong argument that blood pressure lowering, regardless of patients' baseline blood pressure, may contribute to cardiac risk modification, dedicated trials should be designed to address the question of blood pressure lowering in those with blood pressures” that are in the normal range, Meadows said.
The bottom line
New research finds that even people with normal blood pressure and no history of heart disease may benefit from taking blood pressure medications.
The researchers say the findings suggest blood pressure-lowering drugs can help prevent heart disease and stroke in certain people who are at risk of a cardiac event.
Cardiologists say more research is needed to determine what risk factors indicate a person may benefit from taking blood pressure medications.