Blood pressure control, not the specific medication regimen, is what matters

The Blood Pressure Lowering Treatment Trialists’ Collaboration examined primary data from 23 trials as well as summary data from an additional 3 trials to define the cardiovascular effects of lowering blood pressure in people with and without chronic kidney disease.  This study included randomized trials of drugs to lower blood pressure that were compared to placebo or other drugs with at least 1000 patient years of follow up in each treatment arm.  The primary outcome was major cardiovascular events (the composite of stroke, myocardial infarction, heart failure or cardiovascular death), with secondary outcomes of each element of the composite outcome as well as all-cause mortality.  These 26 trials included 152,290 patients, of which 30,295 had impaired renal function (estimated glomerular filtration rate [eGFR] of < 60 mL/min/1.73m2).   Meta-analysis according to baseline kidney function was performed and pooled hazard ratios were estimated per 5 mm Hg lower systolic blood pressure.   Blood pressure lowering was found to reduce the risk of the primary outcome by approximately 17% per 5 mm Hg reduction in systolic blood pressure, regardless of eGFR .  Furthermore, there was no evidence of any difference in effect by choice of blood pressure control regimen.

Conclusion:

This meta-analysis suggests the change in blood pressure, not the regimen chosen for blood pressure control, is most influential in preventing cardiovascular events.

  • Blood Pressure Lowering Treatment Trialists’ Collaboration. Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials. BMJ 2013;347:f5680.