Blood pressure-lowering drugs did not significantly reduce MACE compared to placebo (RR 0.89; 95% CI 0.69-1.14; p=0.35) but significantly reduced stroke and TIA at short-term follow-up.
Meta-Analysis (n=93,121)
Double-blind
Randomized
Do short-term blood pressure lowering drugs reduce major adverse cardiovascular events compared to placebo in adults with hypertension?
Short-term blood pressure lowering therapy (mean 8 weeks) significantly reduces the risk of stroke and TIA, supporting early initiation of treatment in at-risk individuals.
Effect estimate: RR 0.89 (95% CI 0.69-1.14)
Absolute Event Rate: 0.19% vs 0.43%
p-value: p=0.35
Abstract Background There remains uncertainty about the short-term effects of blood pressure (BP) lowering drugs on cardiovascular events. Whether the speed of BP lowering matters is also unknown. As a result, BP guidelines vary in their recommendation for when target BP should be achieved. A greater understanding of the short-term benefits of therapy is imperative to guide clinical decisions about the benefits of early initiation of treatment. Purpose We performed a meta-analysis of double-blind, short-term randomised trials to evaluate the effect of BP-lowering drugs on cardiovascular events compared to placebo. Methods A systematic search for relevant trials was performed in the following databases: MEDLINE, Cochrane Central Register of Controlled Trials Library, and Epistemonikos. Trials satisfying the following criteria were included: (i) randomized, double-blind placebo-controlled trials of 2-26 weeks published in English language; (ii) adults (age ≥18 years) with hypertension (BP ≥140/90 mmHg or taking BP-lowering drugs); (iii) intervention: oral fixed dose of BP-lowering drug(s) as either monotherapy or combination therapy from five major classes (angiotensin converting enzyme, angiotensin-II receptor blockers, calcium channel blockers, beta-blockers, and diuretics); (iv) placebo comparator; (v) reported data on cardiovascular events; (vi). The primary outcome was major adverse cardiovascular events (MACE), defined as stroke, transient ischaemic attack (TIA), myocardial infarction, heart failure hospitalisation, angina or coronary revascularisation. Results 451 trials (93,121 participants mean age 54 years, 56% males, mean follow-up 8 weeks, with a total of 250 cardiovascular events were included. There was no effect of the intervention compared to placebo on MACE (0.19% versus 0.43%; relative risk RR 0.89, 95% CI 0.69-1.14, p=0.35). There was a significant reduction in stroke (0.01% versus 0.05%; RR 0.37 0.19-0.72; p0.001) and TIA (0.001% versus 0.01%; RR 0.26 0.08-0.82; p=0.02). Subgroup analysis suggested combination therapy provided the most benefit in stroke reduction (RR 0.21 0.04-1.01, p=0.05), but benefits were observed across all anti-hypertensive groups for TIA outcomes. There were no between group differences in all-cause or cardiovascular mortality, myocardial infarction, heart failure, angina or coronary revascularisation. Conclusions This meta-analysis of placebo-controlled RCTs demonstrated reduced cerebrovascular events with BP-lowering drugs even at short-term follow up. These findings suggest BP lowering treatment should be initiated as soon as possible in at risk individuals because even 8 weeks of treatment can significantly reduce the risk of stroke/TIA. Shorter time to BP control should be considered in future hypertension guidelines.Summary of Cardiovascular Events
Gnanenthiran et al. (2025) conducted a meta-analysis in Hypertension (n=93,121). Blood pressure-lowering drugs vs. Placebo was evaluated on Major adverse cardiovascular events (MACE), defined as stroke, transient ischaemic attack (TIA), myocardial infarction, heart failure hospitalisation, angina or coronary revascularisation (RR 0.89, 95% CI 0.69-1.14, p=0.35). Blood pressure-lowering drugs did not significantly reduce MACE compared to placebo (RR 0.89; 95% CI 0.69-1.14; p=0.35) but significantly reduced stroke and TIA at short-term follow-up.