Common blood pressure treatments lower the risk of major cardiovascular events

Question

What are the effects of different blood pressure lowering regimens on major cardiovascular events?

Study design

Prospectively designed meta-analysis of randomised controlled trials.

Main results

Twenty-nine RCTs with 2 to 8.4 years follow up were included in the analysis. ACE inhibitors, calcium antagonists or angiotensin-receptor blockers for high blood pressure significantly reduce the risk of major cardiovascular events compared with placebo or control (see Table 1). Setting a lower target blood pressure for treatment significantly reduces the risk of major cardiovascular events compared with setting a higher treatment target. There was no significant difference in the risk of major cardiovascular events among ACE inhibitor, calcium antagonist or diuretic/β-blocker-based treatment regimens. In general, a greater reduction of blood pressure resulted in a greater reduction in the risk of major cardiovascular events.

Table 1 Effects of different treatment regimens on blood pressure and major cardiovascular risk
Treatment regimen	No. of RCTs	Weighted mean difference in blood pressure (SBP/DBP)(mmHg)	RR for major cardiovascular events (95% CI)
Angiotensin converting enzyme inhibitors vs placebo	5	−5/−2	0.78 (0.73 to 0.83)
Calcium antagonist vs placebo	3	−8/−4	0.82 (0.71 to 0.95)
Angiotensin receptor blocker vs control*	4	−2/−1	0.90 (0.83 to 0.96)
Angiotensin receptor blocker vs calcium antagonist	5	+1/+1	0.97 (0.92 to 1.03)
Angiotensin converting enzyme inhibitor vs diuretic or β blocker	6	+2/0	1.02 (0.98 to 1.07)
Calcium antagonist regimens vs diuretic or β blocker	9	+1/+1	1.04 (1.00 to 1.09)
Lower vs higher target blood pressure	4	−4/−3	0.85 (0.76 to 0.95)
*The comparison pooled trials where either some or all people in the non-angiotensin-receptor blocker group received active treatment.

Authors’ conclusions

All widely used blood pressure lowering treatments reduce the risk of major cardiovascular events. A greater reduction in blood pressure leads to a greater reduction in the risk of major cardiovascular events.