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Blood pressure fails to predict CVD risk

By Daniel Cressey

Blood pressure measurements are almost useless for predicting a patient's future risk of heart disease or stroke, a start-ling new NHS study concludes.

The researchers warned targeting blood pressure medication was ineffective and called for far wider use of antihypertensive drugs ­ irrespective of initial BP measurements.

They said the drugs should be used like a vaccine with blanket coverage for everyone over 55

or with a history of heart attack or stroke.

This would treat 98 per cent of those likely to die from cardiovascular events, the study found.

In contrast, targeting blood pressure medication missed most patients, with those in the top 10 per cent for systolic blood pressure suffering only a quarter of subsequent events.

The research found lowering BP by 5mmHg reduced the risk of stroke by 34 per cent and heart disease by 21 per cent ­ regardless of pre-treatment BP.

Study leader Dr Malcolm Law, reader in epidemiology at the Wolfson Institute of Preventive Medicine in London, said blood pressure was a poor predictor of cardiovascular events, and recommended a popula-tion approach to treatment.

'It is like cholesterol ­ it has come down and down until they said "treat everyone". They will do the same with this. It might seem strange to give it to everyone, but we give vaccines to everyone.'

Dr Stewart Findlay, treasurer of the Primary Care Cardiovascular Society and a GP in Bishop Auckland, County Durham, said he would support the move if there was good evidence for it.

He said: 'The workload implications would be huge but we tend to delegate that to nurses nowadays. This would fit with the way we treat cholesterol: if they are already below target we still put them on a statin.'

The researchers, whose study is published on the NHS research findings register, also recommended the term 'hypertension' be scrapped, as it suggested another category of 'normotensives' who would not benefit from lowering BP.

Dr Law said his research had found low doses of a combination of BP-lowering drugs were the most effective treatments with the fewest side-effects.

dcressey@cmpi.biz

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