January 14, 2015
Even Mild Hypertension Should Be Treated to Avoid Cardiovascular Events

Uppsala, Sweden—Drug therapy to lower blood pressure is beneficial even in patients with mild hypertension, defined as systolic blood pressure of 140 to 159 mm Hg and/or diastolic blood pressure of 90 to 99 mm Hg, according to a review led by Swedish researchers.

Medications to reduce blood pressure appear to prevent major cardiovascular events and death in patients with stage 1 hypertension, according to the systematic review published recently in the Annals of Internal Medicine.

The international research team, with leadership from Uppsala University in Uppsala, Sweden, conducted a systematic review of published evidence to determine whether pharmacologic blood pressure reduction prevents cardiovascular events and deaths in persons with mild hypertension, as well as those with more serious disease.

“Most trials of blood pressure–lowering drugs have enrolled persons with grade 2 or 3 hypertension or focused on high-risk persons with established cardiovascular disease,” the authors write. “Extrapolation of the findings from these trials to the setting of grade 1 hypertension and primary prevention has been questioned, although the relative risk reductions achieved with blood pressure–lowering therapy are similar across a broad range of hypertensive and non-hypertensive persons at elevated cardiovascular risk.”

Background in the article points out that elevated blood pressure is the leading cause of premature death globally, and the incidence of clinically abnormal blood pressure is increasing, yet most patients have mild hypertension and no overt cardiovascular disease.”

The study focused on patients without cardiovascular disease with blood pressure in the grade 1 hypertension range. The study subjects had been randomly assigned in a number of trials to either an active—receiving antihypertensive medications or a more intensive blood pressure-lowering regimen—or a control group, where they were given placebo or a less-intensive regimen.

With the individual-patient data involving 10 comparisons from trials where most patients had diabetes, and three where they did not, the average blood pressure reduction was about 3.6/2.4 mmHg.

Over a 5-year period, according to the results, odds ratios were 0.86 (95% CI, 0.74-1.01) for total cardiovascular events, 0.72 (CI, 0.55-0.94) for strokes, 0.91 (CI, 0.74-1.12) for coronary events, 0.80 (CI, 0.57-1.12) for heart failure, 0.75 (CI, 0.57-0.98) for cardiovascular deaths, and 0.78 (CI, 0.67-0.92) for total deaths.

“Blood pressure–lowering therapy is likely to prevent stroke and death in patients with uncomplicated grade 1 hypertension,” the authors conclude.

U.S. Pharmacist Social Connect