2020 in a nutshell: The hottest developments in the field of cardiology this year. Section 1. General and preventive cardiology

2. BPLTTC (Blood Pressure Lowering Treatment Trialists Collaboration) trialBlood pressure medication can prevent heart attacks and strokes—even in people with normal blood pressure.

Debate continues over whether pharmacological blood pressure lowering is equally beneficial in people with, vs. without, a prior heart attack or stroke, and when blood pressure is below the threshold for hypertension (typically 140/90 mmHg). The BPLTTC study set out to examine these questions in detail with researchers combining data on 348 854 individuals who had participated in a randomized clinical trial and conducting a meta-analysis.Participants were divided into two groups: those with a prior diagnosis of cardiovascular disease and those without. Each group was divided into seven subgroups based on systolic blood pressure at study entry (less than 120, 120-129, 130-139, 140-149, 150-159, 160-169, 170 and above mmHg).Over an average four years of follow-up, each 5 mmHg reduction in systolic blood pressure lowered the relative risk of major cardiovascular events by about 10%. The risks for stroke, ischaemic heart disease, heart failure and death from cardiovascular disease were reduced by 13%, 7% and 14% and 5%, respectively.

Neither the presence of cardiovascular disease nor the level of blood pressure at study entry modified the effect of treatment.

"Greater drops in blood pressure with medication lead to greater reductions in the risk of heart attacks and strokes," said principal investigator Professor Kazem Rahimi of the University of Oxford, UK. "This holds true regardless of the starting blood pressure level, in people who previously had a heart attack or stroke, and in people who have never had heart disease." He adds, "This decision will depend on an individual's likelihood of suffering cardiovascular disease in the future – there are a number of risk calculators health professionals can use. Other factors to consider are the potential for side effects and the cost of treatment."Source: journal: PLOS Medicine: Karmali KN, Lloyd-Jones DM, et al Blood Pressure Lowering Treatment Trialists' Collaboration. Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: A meta-analysis of individual participant data. PLoS Med. 2018 Mar 20;15(3):e1002538. doi: 10.1371/journal.pmed.1002538.