Stroke risk? 'Treat those with normal blood pressure'

Ms Valerie Caesar, 46, having her blood pressure taken in October at the Care Harbor four-day free clinic, which offers free medical, dental and vision care to around 4,000 uninsured people in Los Angeles, California.
Ms Valerie Caesar, 46, having her blood pressure taken in October at the Care Harbor four-day free clinic, which offers free medical, dental and vision care to around 4,000 uninsured people in Los Angeles, California.PHOTO: REUTERS

Pressure-lowering drugs benefit those at risk of heart attack even if their readings normal, says study

PARIS • Millions of lives could be saved by giving blood pressure-lowering drugs to people at risk of heart attack and stroke, even if they have normal pressure, researchers said yesterday.

Based on an analysis of 123 medical trials involving more than 600,000 people over two decades, the team called for an urgent review of existing treatment guidelines.

"Our findings clearly show that treating blood pressure to a lower level than currently recommended could greatly reduce the incidence of cardiovascular disease," said the study's lead author Kazem Rahimi of the University of Oxford. This could "potentially save millions of lives".

Blood pressure is recorded as two numbers, written as a ratio, for example 140/90 mmHg (millimetres of mercury - the blood pressure unit).

The number on top is the "systolic" pressure inside the arteries when the heart beats, and the other the "diastolic" pressure between beats, when the heart is at rest and refilling with blood.

According to the American Heart Association, a "normal" pressure is less than 120/80, and becomes high from 140/90.

The study found that every 10 mmHg reduction in systolic blood pressure reduced the risk of heart attack by about a fifth, of stroke and heart failure by about a quarter, and the risk of death from any cause by 13 per cent.

"Importantly, these reductions in disease were similar across a wide range of high-risk patients... irrespective of whether their blood pressure was already low (less than 130 mmHg) to begin with," they wrote.

People at high risk include those with a history of heart or artery disease, stroke, diabetes or heart failure.

The researchers urged a revision of blood pressure guidelines, including those of the European Society of Hypertension which recently relaxed its recommended treatment level for high-risk patients from 130 to 140mmHg of systolic pressure.

"Our results provide strong support for lowering blood pressure to systolic blood pressures less than 130 mmHg," wrote the team.

High blood pressure is the leading cause of heart disease and stroke, said the study authors, affecting more than a billion people worldwide and killing about 9.4 million every year.

The benefits of lowering sustained high pressure are well established, but it has not been clear whether people with "normal" pressure levels would also benefit from treatment.

In Singapore, Dr Leslie Lam of The Cardiac Centre at Mount Elizabeth Medical Centre said there is a need for a re-look at what the normal blood pressure should be.

He added though that he needed to see more data to be convinced that those with normal pressure would need blood-pressure lowering drugs.

AGENCE FRANCE-PRESSE

A version of this article appeared in the print edition of The Straits Times on December 25, 2015, with the headline 'Stroke risk? 'Treat those with normal blood pressure''. Print Edition | Subscribe