Key result
Active pharmacological treatment reduces long-term systolic BP by ~5 mmHg versus placebo.
Why the study?
Evidence from randomised trials on long-term blood pressure reduction from pharmacologic treatment is limited.
Does pharmacological blood pressure-lowering treatment reduce long-term blood pressure in a broad population of adults?
Meta-Analysis (n=352,744)
Yes
Does pharmacological blood pressure-lowering treatment reduce long-term blood pressure in a broad population of adults?
Mean Difference: -5.1 (95% CI -5.3–-5)
Pharmacological antihypertensive treatment effectively lowers long-term blood pressure across diverse patient characteristics, with maximum effects apparent after 12 months.
Objectives Evidence from randomised trials on long-term blood pressure (BP) reduction from pharmacologic treatment is limited. To investigate the effects of antihypertensive drugs on long-term BP change and examine its variation over time and among people with different clinical characteristics Design Individual participant-level data meta-analysis Setting and data source The Blood Pressure Lowering Treatment Trialists’ Collaboration involving 51 large-scale long-term randomised clinical trials Participants 352,744 people (42% women) with mean age of 65 years and mean baseline systolic/diastolic BP of 152/87 mmHg, of whom 18% were current smokers, 50% had cardiovascular disease, 29% had diabetes, and 72% were taking antihypertensive treatment at baseline Intervention Pharmacological BP-lowering treatment Outcome Difference in longitudinal changes in systolic and diastolic BP between randomised treatment arms over an average follow-up of four years Result Drugs were effective in lowering BP, with the maximum effect becoming apparent after 12-month follow-up and with gradual attenuation towards later years. Based on measures taken ≥12 months post-randomisation, more intense BP-lowering treatment reduced systolic/diastolic BP (95% confidence interval) by −11.2 (−11.4 to −11.0)/−5.6 (−5.8 to −5.5) mmHg than less intense treatment; active treatment by −5.1 (−5.3 to −5.0)/−2.3 (−2.4 to −2.2) mmHg lower than placebo, and active arm by −1.4 (−1.5 to −1.3)/−0.6 (−0.7 to −0.6) mmHg lower than the control arm for drug class comparison trials. BP reductions were consistently observed across a wide range of baseline BP values and ages, and by sex, history of cardiovascular disease and diabetes, and prior antihypertensive treatment use. Conclusion Pharmacological agents were effective in lowering long-term BP among individuals with a wide range of characteristics, but the net between-group reductions were modest, which is partly attributable to the intended trial goals.
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A 2021 study conducted a meta-analysis in Hypertension (n=352,744). Pharmacological blood pressure-lowering treatment vs. Placebo, less intense treatment, or standard drug class was evaluated on Difference in longitudinal changes in systolic blood pressure between active treatment and placebo at ≥12 months (MD -5.1 mmHg, 95% CI -5.3 to -5.0). Active pharmacological blood pressure-lowering treatment reduced long-term systolic blood pressure by 5.1 mmHg compared to placebo, and more intense treatment reduced it by 11.2 mmHg compared to less intense treatment.
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