BP-lowering treatment across the spectrum of CV riskHypertensionOpen Access
Blood Pressure-Lowering Treatment Across the Spectrum of Cardiovascular Risk
Blood pressure-lowering treatment across the spectrum of cardiovascular risk: an individual patient data meta-analysis
Why the trial?
Whether the benefit of blood pressure-lowering treatment depends on baseline cardiovascular risk shapes who should be treated and at what threshold. This individual patient data meta-analysis quantified treatment effects across the full spectrum of risk.
Does antihypertensive treatment reduce major cardiovascular disease across different baseline cardiovascular risk categories?
Population
357,440 randomized participants from 51 BP-lowering trials, by risk decile
Comparison
BP-lowering / more intensive regimens vs placebo, active or less intensive
Design
Individual-participant-data meta-analysis of 51 randomized trials
Follow-up
Median 4.2 years
Key result
Antihypertensive treatment reduced major cardiovascular disease (HR 0.90 per 5 mmHg systolic blood pressure reduction), with absolute risk reductions increasing progressively with baseline risk.
Authors
Discussion
Member takes
Overview
BP lowering yields consistent relative CVD reductions across risk strata with greater absolute benefit at higher risk; reinforces uniform application of antihypertensive therapy in guidelines.
Key Points
- To evaluate the relative and absolute effects of blood pressure-lowering treatment on major cardiovascular disease across the full spectrum of baseline cardiovascular risk.
- Conducted an individual-participant-data meta-analysis pooling N=357,440 randomised participants across 51 clinical trials over a median follow-up of 4.2 years.
- Assessed antihypertensive treatment regimens (single/multiple agents or intensive regimens) versus placebo, active comparators, or less intensive regimens across deciles of predicted 5-year cardiovascular risk.
- Blood pressure reduction achieved a hazard ratio of 0.90 per 5 mmHg reduction in systolic blood pressure for major cardiovascular disease, with uniform relative effects across all baseline risk categories (p for interaction >0.99).
- Absolute risk reductions increased progressively with higher baseline predicted risk, rising from 0.4 percentage points in the lowest risk decile to 2.6 percentage points in the highest decile (p for trend <0.001).
Evidence details
What drove the result?
| Major cardiovascular disease |
| HR 0.90 per 5 mmHg SBP reduction; relative effect homogeneous across risk deciles (p for interaction >0.99); CI not reported |
| Absolute risk reduction by baseline predicted risk |
| 0.4 pp in the lowest predicted-risk decile to 2.6 pp in the highest (p for trend <0.001) |
Limitations & tradeoffs
Statistical certainty
No confidence interval for the primary hazard ratio is given in the record.
Background therapy
Pooled comparators are heterogeneous (placebo, active comparators, and less intensive regimens).
Design limitations
The model used to classify predicted 5-year cardiovascular risk is not described, and the record is conference-only with no journal publication and no safety/harms data.
Structured PICO
Does antihypertensive treatment reduce major cardiovascular disease across different baseline cardiovascular risk categories?
P
Population
357,440 randomised participants from 51 trials classified by predicted 5-year cardiovascular risk, followed for a median of 4.2 years.
I
Intervention
Antihypertensive treatment (single or multiple agents, or intensive regimens)
C
Comparator
Placebo, active comparators or less intensive regimens
O
Outcome
Major cardiovascular diseasecomposite
Blood pressure lowering provides consistent relative risk reductions for major cardiovascular disease across all baseline risk levels, with greater absolute benefits seen in higher-risk patients.
Main Result
Hazard Ratio: 0.9
Cite This Study
Kazem Rahimi (2026) conducted a meta-analysis in Cardiovascular risk (n=357,440). Antihypertensive treatment vs. Placebo, active comparators or less intensive regimens was evaluated on Major cardiovascular disease (HR 0.90). Antihypertensive treatment reduced major cardiovascular disease (HR 0.90 per 5 mmHg systolic blood pressure reduction), with absolute risk reductions increasing progressively with baseline risk.