A study published today in the Lancet suggests that blood pressure-lowering drugs should be offered to all individuals at high risk of having a heart attack or stroke regardless of their blood pressure at the start of treatment.
Currently, doctors only offer blood pressure lowering drugs to people considered to have ‘high’ blood pressure. However, the research suggests that even lowering the blood pressure – within reason – of someone with ‘normal’ blood pressure could lower their risk of a heart attack or stroke.
The authors therefore recommend that blood pressure medication should be considered for people with ‘normal’ blood pressure, but a high risk of cardiovascular disease due to factors such as having a history of heart disease.
Professor Peter Weissberg, Medical Director at the British Heart Foundation, said;
“Traditionally, blood pressure is categorised as either high or normal, with current medical guidelines proposing that only people with ‘high’ blood pressure should be offered blood pressure lowering drugs, regardless of their overall risk of heart disease.”
“However, these important findings show that the lower your blood pressure is - within reason - the lower your chance of suffering from a cardiac event such as a heart attack or stroke. “
“This study calls for a reconsideration of how blood pressure lowering drugs should be used to prevent heart attacks and strokes in patients who are already at high risk. It suggests that more lives could be saved and more heart attacks and strokes prevented if doctors considered using blood pressure lowering drugs in patients at high risk of a cardiovascular event, particularly those with a history of cardiovascular disease, even if their blood pressure is not considered ‘high.”
Lowering risk of a heart attack
The current guidelines for treating blood pressure are at odds with the guidelines for treating cholesterol. Doctors offer cholesterol lowering drugs (usually statins) to anyone perceived to be at high personal risk of developing cardiovascular disease, regardless of their cholesterol level.
This means that some patients at high risk of cardiovascular disease are offered statins even when their cholesterol is not particularly high, because the drugs will still help lower their risk of heart disease.
This research points out that it is illogical not to also use this principle when prescribing blood pressure lowering medication.