George Institute Launches Tool to Analyze Medicines' Impact on BP

It allows doctors and researchers to select different drug classes and doses to see the expected average reduction in blood pressure, with results categorised as low, moderate, or high intensity.

The George Institute for Global Health has unveiled an online calculator that predicts how much common blood pressure medications and their combinations will lower systolic blood pressure, following one of the largest analyses of antihypertensive drug trials to date.

The tool is published as a data supplement to a new paper in The Lancet.

It allows doctors and researchers to select different drug classes and doses to see the expected average reduction in blood pressure, with results categorised as low, moderate, or high intensity.

The underlying study analysed data from 484 randomised, double-blind, placebo-controlled trials involving 104,176 participants, with a median follow-up of 8.6 weeks.

The analysis covered five major drug classes: ACE inhibitors, angiotensin receptor blockers (ARBs), beta-blockers, calcium-channel blockers, and thiazide or thiazide-like diuretics.

According to the findings, a single drug at a standard dose reduces systolic blood pressure by an average of 8.7 mmHg. Doubling the dose adds about 1.5 mmHg more reduction.

Using two drugs in combination lowers blood pressure by about 15 mmHg, with a further 2.5 mmHg reduction if both doses are doubled.

“The new calculator provides accurate estimates of the effects of common blood pressure-lowering drugs, both alone and in combination,” said Associate Professor Nelson Wang, cardiologist and Program Head at The George Institute.

“This will help clinicians and patients better select treatments and achieve blood pressure targets.”

The authors noted that treatment efficacy was standardized to a baseline systolic blood pressure of 154 mmHg, and effects vary modestly at lower baseline levels.

The model’s predictions showed good agreement with external dual- and triple-therapy trial data, with a correlation of around 0.76 between predicted and observed values.

The institute described the calculator as part of a shift in treatment thinking, from incremental dose adjustments based on clinic readings to a more structured approach that targets the size of blood pressure reduction required.

“What is needed is a change in paradigm to focus on the size of the blood pressure reduction to be achieved,” said Professor Anthony Rodgers, senior director at The George Institute.

“This approach is very similar to cholesterol management, where treatment is based on the intensity of statins needed to achieve a certain LDL cholesterol reduction.”

Speaking about the research, Dr Mohammad Abdul Salam, Program Head, Cardiovascular Research, The George Institute for Global Health, said, “We cannot overlook the importance of controlling high blood pressure effectively and efficiently. Achieving optimal control requires a clear understanding of the efficacy of antihypertensive drugs at different doses and in various combinations.”

“Without clarity on what we want to achieve and how to achieve it, we will not meet our targets. Guidelines define the target blood pressure, while our online tool helps identify which antihypertensive drugs are best suited to reach that target,” he added.

The George Institute emphasized that the calculator provides population average effects and is not tailored to individual patients.

It does not model long-term adherence or cardiovascular outcomes, as most trials included measured blood pressure over weeks rather than years.

The next step, according to the team, will be a clinical trial testing whether assigning drug regimens based on predicted blood pressure reductions results in faster and more reliable achievement of targets.

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