Achieving recommended BP control is important but no more than addressing other risk factors as well

Blood pressure (BP) is an established risk factor for the development of cardiovascular disease. An intensive regimen of BP control may however lead to increased risk and in this study the authors assess the cardiovascular impact of intensive lowering of diastolic or systolic blood pressure when compared to the overall management of risk factor burden in patients with stable coronary artery disease.

In this study, patients with an increasing number of risk factors for cardiovascular disease were associated with a greater hazard ratio for the composite end point of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke. Unsurprisingly, poorly controlled blood pressure was associated with a higher cardiovascular risk. Unlike LDL-C control however, the mantra “the lower the better” is not necessarily true of BP control which seems to follow a J-curve phenomenon. 

In my mind however, what is important to appreciate from this study is the recognition that >60% of patients had at least one other poorly controlled risk factor. When addressing the cardiovascular risk profile for patients, this paper highlights the importance of seeing patients as a whole and targeting as many risk factors as possible rather than the low-hanging fruit as is often the case.