January 1, 2002Seminars in Vascular Medicine
Blood Pressure and Coronary Heart Disease: A Review of the Evidence
Why the study?
Does blood pressure lowering therapy reduce coronary heart disease events across different populations and blood pressure levels?
Population
Populations from randomized controlled trials and prospective observational studies, including males and…
Comparison
Blood pressure lowering therapy vs Placebo or no treatment
Design
Review
Authors
Discussion
Loading...
Member takes
Implication
Supports BP lowering for CHD prevention across levels and agents; extends prior data but leaves optimal targets open for prospective trials.
Key Points
- To review the totality of evidence from prospective observational studies and randomized controlled trials regarding the relationship between blood pressure levels, blood pressure lowering, and coronary heart disease risk.
- Synthesized findings from large-scale overviews of prospective observational cohort studies and randomized controlled clinical trials.
- Assessed coronary heart disease outcomes across blood pressure strata down to 115 mm Hg systolic, evaluating age groups, sex, regions, and multiple antihypertensive drug classes.
- A continuous association links systolic blood pressure to coronary heart disease down to at least 115 mm Hg, with a 10 mm Hg lower systolic level conferring an approximate one-fifth lower risk in individuals aged 60 to 69 years.
- Blood pressure lowering across major drug classes (diuretics, beta-blockers, ACE inhibitors, calcium antagonists) yields a broadly similar reduction of approximately one-fifth in coronary heart disease events compared with placebo or no treatment.
- Absolute coronary heart disease risk differences associated with blood pressure differences increase with age, and therapeutic benefits accrue even among individuals with average or below-average baseline blood pressure.
Structured PICO
Does blood pressure lowering therapy reduce coronary heart disease events across different populations and blood pressure levels?
P
Population
Populations from randomized controlled trials and prospective observational studies, including males and females across regions, with varying ages (e.g., 60 to 69 years) and blood pressure levels (including average or below average).
I
Intervention
Blood pressure lowering therapy (including diuretics, beta-blockers, ACE inhibitors, and calcium antagonists)
C
Comparator
Placebo or no treatment
O
Outcome
Coronary heart disease (CHD) events, including fatal events and nonfatal myocardial infarctionhard clinical
Blood pressure lowering provides consistent coronary heart disease prevention benefits across populations, even below traditional hypertension thresholds, emphasizing the importance of maximizing blood pressure reduction over the choice of initial agent.
Cite This Study
Lawes et al. (2002) studied this question.