High blood pressure affects as many as 1.3 billion people and leads to around ten million deaths each year. Often called a silent killer, it can remain hidden until it causes heart attack, stroke, or kidney disease, with fewer than one in five patients keeping it under control. Traditional treatment decisions rely on noisy blood pressure readings that fluctuate greatly, making it hard to judge how well drugs work. Now, a first-of-its-kind online tool can predict how much different medications can lower blood pressure.

Researchers at the George Institute for Global Health (Sydney, Australia) have developed the Blood Pressure Treatment Efficacy Calculator, an online tool built from nearly 500 randomized clinical trials involving over 100,000 people. The calculator overcomes the challenge of selecting from dozens of drugs and doses by showing the average treatment effects observed across hundreds of trials. It groups therapies into low, moderate, and high intensity, similar to cholesterol management strategies.

The tool is based on a systematic review and meta-analysis published in The Lancet. A single antihypertensive drug typically lowers systolic pressure by just 8–9 mmHg, while most patients require reductions of 15–30 mmHg. By pooling evidence, the calculator allows doctors to match treatment to the degree of reduction needed, avoiding delays caused by adjusting therapy step by step and reducing the risk of misinterpretation from variable blood pressure readings.

The approach challenges the conventional “start low, go slow, measure and judge” method, which risks inertia and burdens patients with repeated visits. Instead, clinicians can target reductions upfront, prescribing optimal combinations earlier. The next step is a clinical trial where patients will be treated using the calculator’s guidance. Even modest improvements in global hypertension control could save millions of lives, highlighting its potential public health impact.

“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,” said Anthony Rodgers, Senior Professorial Fellow at The George Institute for Global Health. “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.”

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