Antihypertensive drug treatment: the potential, expected and observed effects on vascular disease

Area of Science:

• Cardiovascular epidemiology
• Clinical trials
• Hypertension research

Background:

• Observational studies suggest links between diastolic blood pressure and cardiovascular events.
• Previous estimates of risk reduction may have underestimated the impact of modest blood pressure changes.

Purpose of the Study:

• To re-evaluate the association between long-term diastolic blood pressure differences and the incidence of stroke and coronary heart disease.
• To assess the benefits of antihypertensive drug therapy on stroke and coronary heart disease incidence based on trial data.

Main Methods:

• Re-analysis of prospective observational studies.
• Review and synthesis of results from randomized controlled trials of antihypertensive drug therapy, primarily diuretics.

Main Results:

• A sustained 5-6 mmHg difference in diastolic blood pressure was linked to at least a one-third reduction in strokes and one-fifth fewer coronary heart disease events.
• Antihypertensive therapy achieving similar diastolic blood pressure reductions for a few years largely produced the long-term stroke benefits.
• Treatment significantly reduced coronary heart disease incidence (2P < 0.01), but trial data were insufficient to precisely quantify treatment effects for coronary disease.

Conclusions:

• Modest, sustained reductions in diastolic blood pressure offer significant protection against stroke and coronary heart disease.
• Short-term antihypertensive treatment provides substantial stroke prevention benefits.
• Further research is needed to fully understand the long-term benefits of antihypertensive therapy for coronary heart disease.