Editor's note: BPLTTC trial presented in a Hot Line Session today at ESC Congress 2020. As the leader of the study, Dr.Kazem Rahimi was interviewed by International Circulation（China）.
Dr.Kazem Rahimi
International Circulation：The BPLTTC study led by you has spanned a long time and effectively enhanced people's attention to hypertension management. What new discoveries will you bring us at this ESC conference?
Dr Rahimi: Essentially, we believe this main analysis that we presented at ESC will have some far-reaching implications for clinical practice. What it shows is that an individual’s baseline blood pressure, or the presence or absence of cardiovascular disease does not modify the proportionate treatment effects. This means that treatments should be more widely accessible to populations around the world. We also presented other studies from the BPLTTC at ESC looking at other aspects, but the main analysis that was presented in the Hot Line Session was focused on stratified effects by baseline blood pressure.
International Circulation：As you said, blood pressure management in the 21st century: maximizing gains and minimizing waste. What impact will these new discoveries have on this idea?
Dr Rahimi: The main impact of this discovery around the idea of maximizing benefits whilst minimizing waste is that we can now consider a larger fraction of the population for treatment. It doesn’t provide any answer as to how we should reduce waste. That is something that other studies should investigate. But if we are focusing on cardiovascular disease prevention, there is a large fraction of the population who would potentially benefit from blood pressure reduction, and who we have so far ignored.
International Circulation：In the future, what aspects of BPLTTC research under your leadership will be further deepened?
Dr Rahimi: There are many projects we are currently focused on or are planned. They fall broadly into two categories. One major interest is looking at the safety of blood pressure lowering treatment. For example, there was work also presented at ESC here, looking at the effects of antihypertensives and the risk of cancer. Yet there are other risks that patients and clinicians are concerned about, and the BPLTTC has put a lot of emphasis on looking at those outcomes. The other focus is on outcomes that have not been well studied previously in blood pressure lowering studies, because they are less common, such as vascular disease, dementia or insulin diabetes. We are interested to see whether modifying treatment has effects on those outcomes, and whether those effects are specific to particular drugs. Finally, as we have presented in this study here today, we are interested in stratified effects – whether treatments differ amongst different strands of the population, such as in the very elderly compared to other patient groups.
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