April 29, 2021

expert reaction to study looking at pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure

A study published in the Lancet suggests that blood-pressure lowering medication is effective in reducing relative risk of cardiovascular events in adults, regardless of starting blood pressure level.

Prof Sir Nilesh Samani, Medical Director at the British Heart Foundation said:

“This study again emphasises the importance of controlling blood pressure as well as possible, to reduce the risk of heart and circulatory diseases.

“The benefits of lowering blood pressure are there whether you have pre-existing heart disease or not, and this study shows that lowering blood pressure – even if it is in the normal range – is associated with fewer heart attacks and strokes.

“This doesn’t mean we should treat everyone with blood pressure lowering drugs. If someone already has a low risk of heart disease, a 10 per cent reduction in their blood pressure may only carry a small direct benefit.

“Ultimately, the decision to treat blood pressure and the target level to aim for is something that requires a conversation between the patient and the doctor.  It’s also important to remember that blood pressure can be improved by means other than medication such as exercise and losing weight.”

Prof Gavin Sandercock, Professor School of Sport, Rehabilitation and Exercise Sciences, University of Essex, said:

“This is an accurate reflection of the science and is high-quality evidence that lowering blood pressure can reduce heart disease.

“All these studies only compare drugs with no treatment – non compare with dietary intervention or, more importantly exercise.  The press release also glosses over the manifold negative (side) effects of blood pressure lowering drugs.  Regardless of which drug is given there are common side effects such as dizziness and headache that can persist in many people for the whole time they take the drug.  Some drugs like ACE inhibitors, which are most commonly-used also cause rashes and a persistent dry cough.

“(Side effects by drug: Beta-blockers – dizziness, headaches, tiredness, and cold hands and feet; Diruetics – dizziness when standing up, increased thirst, needing to go to the toilet frequently, and a rash; Calcium channel blockers – headaches, swollen ankles and constipation; ARBs – dizziness, headaches, and cold or flu-like symptoms; ACE inhibitors – persistent dry cough, headaches dizziness and rash.)

“The 5 mm/Hg reduction in blood pressure shown in this review is easily achievable with small lifestyle changes in diet and taking regular moderate intensity physical activity.  Unlike drugs, the ‘side effects’ of physical activity are largely positive.

“(Side effects of physical activity: Improved fitness, strength and stamina; Weight loss and muscle gain; Improved self-esteem, self-efficacy and better psychological well-being; Greater social interaction and decreased feelings of social isolation (group exercise only).)”

‘Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis’ by The Blood Pressure Lowering Treatment Trialists’ Collaboration was published in the Lancet at 23:30 UK time on Thursday 29 April 2021.

Declared interests

Prof Gavin Sandercock: “I have no conflict of interest to declare.”

None others received.