Key Points
- To review prospective cohort studies and randomized clinical trials evaluating the quantitative relationship between blood pressure reduction and stroke incidence across diverse populations.
- Reviewed major prospective cohort studies from the Asia Pacific region, North America, and Western Europe.
- Conducted an updated meta-analysis of >40 randomized controlled trials of blood pressure lowering comprising >188,000 participants and approximately 6,800 stroke events (mean age at event ~70 years).
- In prospective cohort studies, each 10 mm Hg lower systolic blood pressure was associated with an approximate one-third reduction in stroke risk in individuals aged 60 to 79 years, remaining continuous down to at least 115/75 mm Hg.
- Meta-analysis of randomized controlled trials demonstrated that a 10 mm Hg reduction in systolic blood pressure lowered stroke risk by approximately one third.
- Relative risk reductions per mm Hg systolic reduction were consistent across baseline blood pressure levels, drug classes, sex, region, and cardiovascular disease history, with larger blood pressure reductions yielding greater stroke prevention.
Structured PICO
Does blood pressure lowering reduce the risk of stroke?
PPopulation>188,000 participants from >40 randomized controlled trials and major overviews of prospective cohort studies
IInterventionBlood pressure lowering drugs
CComparatorControl or less intensive blood pressure lowering
OOutcomeStroke (fatal and nonfatal events)hard clinical
Initiating and maintaining blood pressure reduction is crucial for stroke prevention, with a 10 mm Hg reduction in systolic BP lowering stroke risk by approximately one third regardless of the specific agent used.