Antihypertensive Drug Therapy for Less Than 5 Years May Not Reduce Mortality or Cardiovascular Events in Adults with Mild Hypertension

DynaMed Weekly Update - Volume 7, Issue 37

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A large proportion of patients diagnosed with hypertension have Stage 1 (mild) elevations in blood pressure, defined as systolic blood pressure 140-159 mm Hg or diastolic blood pressure 90-99 mm Hg. Many of these patients may have no other indications of cardiovascular disease, but antihypertensive medications are frequently prescribed for primary prevention, as recommended by the Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) (Hypertension. 2003 Dec;42(6):1206). A recent Cochrane review compared antihypertensive drug therapy to placebo or no treatment in patients with mild hypertension.

Data from 8,912 patients from 4 randomized trials with treatment duration 2-5 years were analyzed. Subgroups of patients with mild hypertension were selected from 3 of the trials (7,900 patients, mean age 52 years). In a fourth trial, subgroup data were not available, but > 80% of the 1,012 participants had mild hypertension (mean age 38 years). First-line antihypertensive drugs included thiazide or thiazide-like diuretics, beta blockers or reserpine with additional therapies as needed.

Comparing any antihypertensive treatment to controls, there were no significant differences in mortality (risk ratio [RR] 0.85, 95% CI 0.63-1.15), incidence of coronary heart disease (RR 1.12, 95% CI 0.8-1.57), or total cardiovascular events (RR 0.97, 95% CI 0.72-1.32) (level 2 [mid-level] evidence). Antihypertensive treatment was associated with a trend toward reduced risk of stroke (0.3% with antihypertensives vs. 0.7% with control, p = 0.078) in an analysis of the largest trial (6,061 patients with mild hypertension). In an analysis of all 17,354 patients in that trial, including those with more severe hypertension, antihypertensive treatment was associated with increased withdrawals for adverse events (11.3% vs. 2.3%, p< 0.0001, NNH 11) (Cochrane Database Syst Rev 2012 Aug 15;(8):CD006742). This analysis is limited by the short duration of the included trials, which might limit the power to detect differences in mortality and other hard outcomes.

For more information, see the First-line therapy for hypertension topic in DynaMed.