Meta-Analysis of 357,440 Participants Supports Risk-Based Blood Pressure Treatment Over Threshold Approach
The ESC-presented meta-analysis demonstrates uniform relative cardiovascular benefit from blood-pressure reduction irrespective of baseline risk, supporting a shift toward risk-stratified prescribing. Absolute gains remain greatest in higher-risk patients, but current UK guidelines may under-treat some high-risk individuals with only mildly elevated pressures. Evidence quality is high for relative effects yet moderate for policy impact pending implementation trials.
Next steps require an updated individual-patient meta-analysis incorporating recent SGLT2-inhibitor and GLP-1-receptor-agonist trials, followed by a pragmatic cluster-randomised evaluation of risk-based versus threshold-based prescribing in UK primary care to quantify changes in event rates and prescribing volume within three years.
NICE: Updated hypertension guideline incorporating risk-based selection criteria will be published by December 2027.
Sources (2)
- [1]Primary Source(https://www.escardio.org/Congresses-Events/ESC-Congress)
- [2]Supporting Source(https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01921-8/fulltext)