Do blood pressure lowering drugs reduce cardiovascular disease events in individuals regardless of pretreatment blood pressure or existing cardiovascular disease?
Blood pressure lowering drugs provide similar proportional reductions in cardiovascular events regardless of baseline blood pressure, suggesting treatment could be offered broadly based on age rather than specific blood pressure thresholds.
With the exception of the extra protective effect of beta blockers given shortly after a myocardial infarction and the minor additional effect of calcium channel blockers in preventing stroke, all the classes of blood pressure lowering drugs have a similar effect in reducing CHD events and stroke for a given reduction in blood pressure so excluding material pleiotropic effects. The proportional reduction in cardiovascular disease events was the same or similar regardless of pretreatment blood pressure and the presence or absence of existing cardiovascular disease. Guidelines on the use of blood pressure lowering drugs can be simplified so that drugs are offered to people with all levels of blood pressure. Our results indicate the importance of lowering blood pressure in everyone over a certain age, rather than measuring it in everyone and treating it in some.
Law et al. (2009) studied this question.