Blood Pressure Treatment Shows Consistent Benefit Across Cardiovascular Risk Spectrum

Treatment with antihypertensive medications resulted in consistent cardiovascular disease risk reduction and absolute benefits across patients with various levels of cardiovascular risk, according to a recent IPD analysis.¹

These data were presented at the European Society of Cardiology (ESC) Congress 2026 in Munich, Germany, by Kazem Rahimi, MD, professor of cardiovascular medicine and population health and director of the Deep Medicine program at the University of Oxford. The study follows Rahimi’s previous publication of a meta-analysis of long-term antihypertensive treatment on cardiovascular risk.¹

“There have been previous studies that have tried to look at this, but they were essentially smaller in sample size,” Rahimi told HCPLive in an interview. “As a consequence of that, we were not confident as to whether treatment works in low-risk individuals.”

The previous study was an IPD meta-analysis of 51 randomized trials of blood pressure (BP)-lowering drugs versus placebo, active control, or differing intensities. Trials were also required to have ≥1000 patient-years per arm. These trials were also utilized for the present study, which was conducted in the same format. Among the included trials were 20 placebo-controlled studies, 23 active-controlled studies, and 8 intensity trials. The primary outcome of the analysis was first major cardiovascular event, including stroke, ischemic heart disease, or heart failure causing death or hospitalization.^1,2

Across all 51 trials, a total of 357,440 patients were enrolled in the analysis. Patients had a mean age of 65 years (standard deviation [SD], 9.7), and 41.6% (n = 148,602) were women. Mean baseline BP was 152/87 mmHg. Patients were divided into 10 deciles, with a 14-fold gradient in predicted risk. The total population had a median risk of 12.3% (interquartile range [IQR], 7.6-19).¹

Among patients in the first decile (<4% predicted risk), mean predicted risk was 3% and the proportion of patients with established cardiovascular disease or diabetes was 11.6% and 11.1%, respectively. In contrast, Decile 10 (>27% predicted risk) saw a mean predicted risk of 41.6%, with a mean age of 72.8 years and a proportion of patients with established cardiovascular disease or diabetes of 55.4% and 53.8%, respectively. However, Rahimi and colleagues noted relatively similar BP between the lowest and highest decile; mean systolic/diastolic BP was 153.5/91.3 mmHg and 158.4/83.2 mmHg, respectively.¹

Ultimately, Rahimi and colleagues found that intervention, regardless of the form it took, resulted in a significant and consistent reduction in the risk of the primary outcome. Among Decile 1, 1.9% of patients receiving BP-lowering medication experienced a first major cardiovascular event versus 2% of the comparator arm. Decile 10 saw 11.4% of the intervention arm experience the primary outcome, while 13% of comparator recipients had a first major cardiovascular event.¹

However, Rahimi and colleagues also noted a negligible impact of BP beyond predicted cardiovascular disease risk. While absolute risk reduction increased progressively with baseline predicted risk, it did not substantially increase by BP. Additionally, adverse events, including palpitations, bradycardia, hypotension, end-stage renal disease, and syncope, were more frequent among patients receiving treatment.¹

Ultimately, Rahimi argues that this study supports an expanded role of risk-based treatment, prioritizing more direct targeting over higher numbers of patients treated. Additionally, while BP is still relevant to determine the potential magnitude of reduction, risk should be the primary decision-making factor over only BP.¹

“If someone is eligible for treatment, you should try early, and experiment with different strategies,” Rahimi said. “The common practice that we see is to just start with very low-dose treatment and invite the patient to come back a few months later; this, unfortunately, foregoes the opportunity for prevention, and is unlikely to be a good strategy from patients’ perspective.”

Editors’ Note: Rahimi reports disclosures with Medtronic and grants from the UK Research and Innovation, the European Union, and the Medical Research Council.

References

1. Rahimi K, Bidel Z, Nazarzadeh M, et al. Blood pressure-lowering treatment across the cardiovascular risk spectrum. Presented at the European Society of Cardiology (ESC) Congress 2026, Munich, Germany. August 28-31, 2026.

2. Yang, Q., Bidel, Z., Canoy, D. et al. A meta-analysis of the long-term effects of antihypertensive therapy on the risk of major cardiovascular disease across 51 randomized trials. Nat Med 32, 3082–3092 (2026). https://doi.org/10.1038/s41591-026-04514-3