Do High Blood Pressure Medications Improve Patient Outcomes?

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In a recently published review, researchers examine the relationship between antihypertensive medications and the risk of major cardiovascular events.

How is Blood Pressure Measured?

When the heart beats, it pushes blood through your arteries to the rest of your body.  This creates pressure in the blood vessels.  The amount of pressure in the arteries is called systolic pressure. The pressure in the arteries when the heart is between beats is called diastolic pressure. When blood pressure is measured, it is expressed as a fraction with the systolic pressure on top and the diastolic pressure on the bottom. Both numbers are important in assessing the health of your heart.  Numbers higher than 120/80 are an indication that your heart is working too hard to pump blood to the rest of your body.

Blood pressures in the range of 120/80 to 140/90 mean that you have prehypertension.  While treatment may not be necessary, you may be advised to eat a more balanced diet and exercise more regularly. An individual is generally diagnosed with hypertension (high blood pressure) when blood pressure measures are higher than 140/90. Since individuals with hypertension are at increased risk of heart disease and stroke, doctors typically prescribe antihypertensive medications to pair with lifestyle changes. These include:

  • Alpha-blockers or calcium channel blockers used to relax blood vessels.
  • Beta-blockers to lower the heart rate and relax blood vessels.
  • Diuretics to decrease the amount of fluid in your body and your veins.

Do High Blood Pressure Medications Improve Patient Outcomes?

In a recent review of the literature published in JAMA Internal Medicine, Swedish researchers summarized the data on the relationship between the use of antihypertensive medications and patient risk of major cardiovascular events or mortality.

Their meta-analysis included 74 trials, with more than 300,000 patients (40% women, 60% men, and an average age of 63.6 years). They found baseline systolic blood pressure levels to be the most important indicator of the effectiveness of high blood pressure medications in preventing major cardiovascular events or death.

They found that treatment with medications to lower blood pressure reduced the risk of cardiovascular disease or death only if baseline systolic blood pressure was 140 mm Hg or higher. Blood pressure medications significantly reduced the risk of both cardiovascular events and death when baseline systolic blood pressure was greater than 160 mm Hg.  In individuals with baseline systolic blood pressure between 140 and 160 mm Hg, medication significantly reduced the risk of death from a major cardiovascular event.

These findings suggest that although prescribing medications to lower blood pressure may be considered, they appear to be most effective in preventing cardiovascular disease and death when baseline systolic blood pressure is greater than 140 mm Hg.

Written by Debra A. Kellen, PhD

 

Reference: Mattias Brunström, Bo Carlberg. Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels: A Systematic Review and Meta-analysis. JAMA Intern Med. Published online November 13, 2017. doi:10.1001/jamainternmed.2017.6015

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