Treatment of mild hypertension is not associated with improved outcomes

Treating patients with mild hypertension for primary prevention does not significantly reduce their morbidity or mortality, according to a new Cochrane review.

The review included four randomized controlled trials with almost 9,000 participants, in which antihypertensive drugs were compared to placebo. Participants had no cardiovascular disease and mildly elevated blood pressure (systolic 140 to 159 mm Hg and/or diastolic 90 to 99 mm Hg).

The review was published by The Cochrane Library on Aug. 15.

Antihypertensive drug treatment for four or five years resulted in a nonsignificant decrease in mortality (relative risk [RR], 0.85; 95% CI, 0.63 to 1.15). Compared to those taking placebo, patients on antihypertensives also had similar risks of coronary heart disease (RR, 1.12; 95% CI, 0.80 to 1.57), stroke (RR, 0.51; 95% CI, 0.24 to 1.08) and total cardiovascular events (RR, 0.97; 95% CI, 0.72 to 1.32). Treated patients were more likely to withdraw from medication due to adverse effects, however; 9% of them did so (RR, 4.80; 95% CI, 4.14 to 5.57).

Study authors concluded that antihypertensives have not been proven to significantly reduce any primary prevention outcome in patients with mild hypertension. They noted that the nonsignificant decreases found for mortality and stroke allow for the possibility of benefit if a larger number of patients and events could be studied.

The authors noted that it is difficult to get more definitive data because mild hypertension is usually associated with a low risk of adverse events, but they called for a large randomized controlled trial in this patient population to better assess the risks and potentially find a cutoff point at which hypertension treatment provides benefit.

The review's findings conflict with current hypertension treatment guidelines in the U.S., Canada and Europe, the authors noted. If patients were aware of the evidence regarding drug treatment of mild hypertension, many might choose nondrug treatment, the review authors speculated. Physicians should also advise patients of the risk of adverse effects from treatment, they advised.