Health Talk| Intensive BP control can reduce risk of heart attack, stroke: Study

To better understand the benefits and harms of intensive blood pressure control, authors analysed data from over 80,000 participants

A new study published in *The Lancet* last week noted that for people diagnosed with high blood pressure, intensive blood pressure control (defined as using medication and lifestyle changes to lower a person’s systolic blood pressure to below 120 mm Hg or 130 mm Hg) can reduce the risk of major cardiovascular events, including heart attack and stroke.

Doctors often recommend medicines and lifestyle changes to lower blood pressure, but there has been debate about the safety and risks of aiming for lower blood pressure targets. (Freepik/ Representative photo)

The study, titled Benefit–harm trade-offs of intensive blood pressure control versus standard blood pressure control on cardiovascular and renal outcomes: an individual participant data analysis of randomised controlled trials, is, according to the authors, the most comprehensive analysis to date on the benefit–harm profile of intensive blood pressure control, offering robust evidence to guide patient-centred hypertension treatment worldwide.

High blood pressure (hypertension) is a common health problem that increases the risk of heart disease and stroke. Doctors often recommend medicines and lifestyle changes to lower blood pressure, but there has been debate about the safety and risks of aiming for lower blood pressure targets—specifically, reducing systolic blood pressure to below 120 mm Hg or below 130 mm Hg, which is lower than the standard target of 140 mm Hg.

Although intensive blood pressure control is recommended by major guidelines, its overall benefit–harm balance remains uncertain, said authors in the paper. In particular, they said that it was unclear how net clinical benefit varies by blood pressure target and patient characteristics. Therefore, they aimed to quantify the benefit–harm trade-offs of intensive blood pressure control versus standard blood pressure control.

To better understand the benefits and harms of intensive blood pressure control, authors analysed data from over 80,000 participants across six major clinical trials that tested different blood pressure targets. They found that people whose blood pressure was lowered intensively experienced fewer heart attacks, strokes, and cardiovascular-related deaths compared to those treated with standard blood pressure goals. However, these people did experience more side effects such as dizziness, fainting, arrhythmia, and kidney problems.

“Compared with standard blood pressure control, intensive blood pressure control provides a net benefit between the reduction in cardiovascular events and the increase in adverse events, including renal events,” said the authors in the study.

Importantly, the study suggests that both blood pressure targets—below 120 mm Hg and below 130 mm Hg—provided net benefits, with some variation based on patient age, existing health conditions, and baseline blood pressure.

Compared with standard blood pressure control, intensive blood pressure control was associated with a 1.73% absolute risk reduction in cardiovascular disease and a 1.82% absolute risk increase for adverse events of interest. Overall, intensive blood pressure control showed a favourable benefit–harm profile, with a net benefit of 1.14, the authors found.

They added that these findings support a shift in clinical practice toward a more nuanced, patient-centred approach to blood pressure management. Goes without saying that this is the ideal approach in treating any chronic condition.