Researchers created a tool to estimate how much different drugs lower blood pressure. It may transform hypertension care by improving treatment selection and saving lives.
A newly developed Blood Pressure Treatment Efficacy Calculator, the first of its kind, was created using data from nearly 500 randomized clinical trials involving more than 100,000 participants. The tool enables physicians to estimate how much different medications are expected to reduce blood pressure.
The findings, published in The Lancet, suggest this resource could change the way hypertension is managed by helping doctors tailor treatment plans to the exact level of blood pressure reduction each patient requires.
“This is really important because every 1mmHg reduction in systolic blood pressure lowers your risk of heart attack or stroke by two percent,” said Nelson Wang, cardiologist and Research Fellow at The George Institute for Global Health.
“But with dozens of drugs, multiple doses per drug, and most patients needing two or more drugs, there are literally thousands of possible options, and no easy way to work out how effective they are,” he said.
Addressing complexity in treatment choices
The calculator addresses this problem by averaging treatment effects across hundreds of clinical trials. It also classifies therapies into low, moderate, or high intensity groups, depending on how much they reduce blood pressure (BP), a method already widely applied in cholesterol-lowering treatments.
Typically, a single antihypertensive drug—the most common first step in treatment—reduces systolic BP by only 8–9 mmHg. However, many patients require drops of 15–30 mmHg to achieve recommended targets.
According to Dr. Wang, the traditional strategy of adjusting treatment based on individual blood pressure readings is flawed, since BP values fluctuate widely and are often too “noisy” to provide reliable guidance.
“Blood pressure changes from moment to moment, day to day, and by season – these random fluctuations can easily be as big or larger than the changes brought about by treatment,” he said.
“Also, measurement practices are often not perfect, bringing in an additional source of uncertainty – this means it’s very hard to reliably assess how well a medicine is working just by taking repeated measurements.”
Moving beyond the traditional approach
Anthony Rodgers, Senior Professorial Fellow at The George Institute for Global Health, said that while hypertension, or high blood pressure, is the most common reason people visit their doctor, there has been no single, up-to-date resource to show how effective different blood pressure medications are—especially when used in combination or at varying doses.
“Using the calculator challenges the traditional ‘start low, go slow, measure and judge’ approach to treatment, which comes with the high probability of being misled by BP readings, inertia setting in or the burden on patients being too much,” he said.
“With this new method, you specify how much you need to lower blood pressure, choose an ideal treatment plan to achieve that based on the evidence, and get the patient started on that ideally sooner rather than later.”
Global health implications
The next step is to test this new approach in a clinical trial, where patients will be prescribed treatments based on how much they need to lower their blood pressure, guided by the calculator.
High blood pressure is one of the world’s biggest health challenges, affecting as many as 1.3 billion people and leading to around ten million deaths each year.
Often called a silent killer as it does not cause any symptoms on its own, it can remain hidden until it leads to a heart attack, stroke or kidney disease. Fewer than one in five people with hypertension have it under control.
“Given the enormous scale of this challenge, even modest improvements will have a large public health impact – increasing the percentage of people whose hypertension is under control globally to just 50% could save many millions of lives,” Professor Rodgers added.
The Blood Pressure Treatment Efficacy Calculator can be accessed at www.bpmodel.org.
Reference: “Blood pressure-lowering efficacy of antihypertensive drugs and their combinations: a systematic review and meta-analysis of randomised, double-blind, placebo-controlled trials” by Nelson Wang, Abdul Salam, Rashmi Pant, Amit Kumar, Rupasvi Dhurjati, Faraidoon Haghdoost, Kota Vidyasagar, Prachi Kaistha, Hariprasad Esam, Sonali R Gnanenthiran, Raju Kanukula, Paul K Whelton, Brent Egan, Aletta E Schutte, Kazem Rahimi, Otavio Berwanger and Anthony Rodgers, August 30, 2025, The Lancet.
DOI: 10.1016/S0140-6736(25)00991-2
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