Evidence to Treat: The Benefits of Blood Pressure Reduction Even in Mild Hypertension | Journal Scan

Study Questions:

Does pharmacologic blood pressure reduction prevent cardiovascular events and deaths In patients with stage 1 hypertension (systolic blood pressure of 140-159 mm Hg and/or diastolic blood pressure of 90-99 mm Hg) and without overt cardiovascular disease?


This was a meta-analysis of published and individual-level data from randomized, controlled trials. The authors built upon a previously published systematic review. Studies were eligible if at least 80% of patients had grade 1 hypertension and if an antihypertensive drug provided as monotherapy or a stepped-care algorithm was compared against placebo or another control regimen. Outcomes of interest were major cardiovascular events, cardiovascular deaths, and total deaths.


The total study sample included 15,266 patients; 5.1% of patients (661 of 12,981 patients with available data on cardiovascular disease) developed a cardiovascular event. The average blood pressure reduction among patients in the trials in the Blood Pressure Lowering Treatment Trialists’ Collaboration was 3.6/2.4 mm Hg (the values were unknown for other contributing trial subgroups). Blood pressure lowering therapy led to statistically significant reductions in stroke (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.55-0.94), cardiovascular deaths (OR, 0.75; 95% CI, 0.57-0.98), and total deaths (OR, 0.78; 95% CI, 0.67-0.92).


The authors concluded that in this meta-analysis, blood pressure lowering therapy in patients with stage 1 hypertension without overt cardiovascular disease was associated with significant reductions in strokes and death.


As the authors discuss, most trials of blood pressure lowering therapies have enrolled high-risk patients or those with grade 2 or 3 hypertension. This is an important meta-analysis that establishes the beneficial effects of blood pressure lowering in those with milder hypertension and without cardiovascular disease. Although the study is limited by modest blood pressure reductions and a moderate number of total events (as the authors acknowledge), the results from this analysis reinforce the benefits of blood pressure reduction in those with grade 1 hypertension.

Clinical Topics: Prevention, Hypertension

Keywords: Blood Pressure, Antihypertensive Agents, Hypertension, Hypotension, Stroke, Cardiovascular Diseases, Algorithms, Primary Prevention

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