Should Everyone Take Blood Pressure Medication?

Two London researchers conducted a meta-analysis of 147 randomized clinical trials of high blood pressure medications, and came to the conclusion that blood-pressure-lowering drugs should be offered to everyone, regardless of their actual blood pressure. This would increase protection against coronary heart disease and stroke, they claim. The findings on which they based their conclusions are published in the British Medical Journal.

There were nearly 1 million people in the 147 studies, whose ages ranged between 60 and 70. The data were analyzed to determine effects of different classes of blood pressure medications on the risk of coronary heart disease and stroke. The drug classes were thiazides, beta-blockers, ACE-inhibitors, ARB’s, and calcium channel blockers. Overall, the reduction in risk with multiple medications was 46% for coronary heart disease and 62% for stroke. For those only taking one drug, these beneficial effects were about halved. Calcium channel blockers were found to be more effective in preventing stroke than the other 4 drug classes; however, they reduced the frequency of heart failure by only 19%, compared with the others, who did so at 24%.

People with and without cardiovascular disease at baseline had equal benefits, and blood pressure levels before treatment made no difference. Even those with pressures considered being low – 110 mm Hg systolic and/or 70 mm Hg diastolic – had fewer cardiovascular events and strokes when taking anti-hypertensive medication.

The results show that lowering blood pressure by medication is clearly beneficial for just about anyone, regardless of their starting blood pressure. It’s interesting that the authors of are the protagonists for the polypill. Their findings provide support for their concept, suggesting that many people over a given age should take medications, such as antihypertensives, without specific checks on their health. A word of warning comes from Dr Franz Messerli, an expert in hypertension, who says: “A meta-analysis is like a sausage; only God and the butcher know what goes in it and neither would ever eat it”. Further studies in the next few years (and I don’t mean meta-analyses) will clarify evidence for the full polypill concept, or one confined to, say, just controlling blood pressure.