Professor Kazem Rahimi of Oxford University described the results of his collaborative clinician for blood pressure lowering (BPLTTC) trial, which he presented at the 2020 European Heart Association Virtual Conference.
This transcript has been edited for clarity.
What was the discovery of your headline?
The finding of the headline was that hypotension functions equally well with or without cardiovascular disease and with baseline pressure values up to a level of 120 mm mercury or less.
How did you come to a conclusion?
To achieve that result, a huge amount of data had to be collected to see the differences between individual subgroups. And this work is actually a combination of data collection and processing activities that began in 2014 with the cooperation of leading clinical trial physicians around the world. There are about 50 randomized clinical trials, large randomized clinical trials, in which researchers shared data with us, a complete dataset. And basically put all the data together in one dataset. And I was able to perform the stratified analysis presented at this meeting.
And, in this particular study, apparently whether the treatment effects differ in people with previous cardiovascular disease, and the blood pressure itself, systolic blood pressure.
Currently, the database itself contains about 350,000 randomized individuals, making it, to my knowledge, the largest source of randomized trials to date.
Do the exercises need to change now?
Looking at what is happening worldwide, the interpretation of current evidence is quite divergent. In some areas, such as the United States, people with a history of cardiovascular disease should probably not be distinguished, or [those who] I didn’t. In other parts of the world, such as Europe and England, there was a clear distinction between those people. And no matter where you look, doctors and the people who put together those guidelines, the perceptions of those experts, are almost irrelevant, and if you want to consider treatment with an antihypertensive drug, the starting point should look at the individual about it” [initial] blood pressure.
This study fundamentally challenges the idea and suggests that the presence of blood pressure itself, or lack of cardiovascular disease, is not a reason to withhold treatment among those individuals. We believe this will have a great impact on clinical practice.
For example, what else should the National Institute of Health Care Excellence (NICE) do, for example?
NICE currently has two different guidelines. Hypertension treatment, It is a person who has never had a cardiovascular disease before, Cardiovascular risk management People who have had cardiovascular disease before.
One question this study raises is Cardiovascular risk management, Are you using the same medication? That is one question.
The second side is High blood pressure Currently, in guidelines for people with no history of cardiovascular disease, NICE makes it very clear that the starting point for an assessment is an individual’s systolic blood pressure above 140.
In other words, if your blood pressure is 139, you should not be considered for treatment, even if your risk of cardiovascular disease is high.
I think this research challenges that. And, as you know, NICE rigorously evaluated previous evidence. For individuals in that particular category, we found little definitive evidence for blood pressures below 140. And this study should fill that gap exactly. We have a significant number of individuals, actually thousands of people, and thousands of events, and they can reassess the situation.
Are you surprised by the survey results?
We have previously conducted a study that, by some criteria, provided evidence for treatment changes due to baseline blood pressure or disease.
But what we admitted, and what NICE noticed, was that there was actually limited evidence for the category of hypotension. Yes, what surprised me was that when I put that data together at the individual level, the amount of information that was actually available today and the number of people who had only normal or high blood pressure randomized the key data. .. Clinical trial.
So this is important. So, for example, comparing one of the biggest meta-analyses with tabular data I’ve used so far, Published in Lancet In 2015, there were very few people in that category or very few tests. There are at least 6 times more events occurring in these personal categories here. This is amazing: the amount of information.
To be honest, this is what we expected, but the nature of science is unknown to us. So, as you know, the protocol is pre-specified. We knew there was a reason why experts around the world disagree about what to do in that category.
From a physiological point of view, I believed it shouldn’t be distinct, but I didn’t know what the results would be.
And that’s amazing, and to some extent, just checking it makes no difference.
How do you find virtual meetings compared to face-to-face networking?
This has advantages and disadvantages. So what’s missing is that it’s actually a social interaction with people, or a pre-recorded presentation, where you simply respond and you lose instant feedback. But, on the other hand, it gives you more flexibility to access the information and allows more audiences to access the meeting. In other words, more than 100,000 users who have never registered have registered. For science, we want more people to have access to that information.
