When Should Blood Pressure be Lowered?

High blood pressure (hypertension) is a well-known risk factor for cardiovascular disease and the adverse cardiovascular events associated with it, such as stroke, heart attack, congestive heart failure, and even death. High blood pressure should always be treated. But what about “prehypertension”, when blood pressure is between the usual definition of hypertension (systolic/diastolic >140/90 mmHg) and “normal” blood pressure (<120/80)?

In a recent meta-analysis of 25 different studies, patients with a history of cardiovascular disease but without clinically defined hypertension were treated with antihypertensive medications to lower their blood pressures a little anyway. Most of the patients started with blood pressures in the prehypertensive range. Treatment with antihypertensive drugs lowered blood pressure, as expected. It also lowered the risk of stroke (by 23%), heart attack (20%), congestive heart failure (29%) and death (13%), compared to patients treated with a placebo.

All of the patients in these studies had a prior history of cardiovascular disease. But the findings raise an interesting question: Would lowering the blood pressures of otherwise healthy people with prehypertensive blood pressures reduce their risk of ever developing cardiovascular disease in the future? You can bet that the drug companies are interested. Think of the potential increase in the market size for antihypertensive drugs if the drugs could be recommended for millions of healthy people, not just for patients with a history of cardiovascular disease!