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Pharmacotherapy for mild hypertension.

Diana Diao1, James M Wright, David K Cundiff

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Antihypertensive drugs do not reduce mortality or morbidity in mild hypertension patients without prior cardiovascular disease. However, 9% of patients discontinued treatment due to adverse effects, necessitating further research.

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Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Primary prevention population consists of individuals without prior cardiovascular events or disease.
  • The benefits and harms of treating mild hypertension in this group remain unknown.
  • This review examines existing randomized controlled trial (RCT) evidence.

Purpose of the Study:

  • To quantify the effects of antihypertensive drug therapy on mortality and morbidity.
  • Focus on adults with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) and no history of cardiovascular disease.

Main Methods:

  • Searched CENTRAL, MEDLINE, EMBASE, and reference lists up to 2011.
  • Included RCTs of at least 1-year duration comparing antihypertensive drugs to placebo or no treatment.
  • Assessed outcomes included mortality, stroke, coronary heart disease (CHD), total cardiovascular events (CVS), and adverse effect withdrawals.

Main Results:

  • Four RCTs with 8,912 participants were included.
  • Antihypertensive drugs (4-5 years) did not reduce total mortality (RR 0.85) or CHD (RR 1.12).
  • No significant reduction in stroke (RR 0.51) or total CVS (RR 0.97) was observed; however, withdrawals due to adverse effects increased significantly (RR 4.80, ARR 9%).

Conclusions:

  • Antihypertensive drugs have not demonstrated reduction in mortality or morbidity for primary prevention in mild hypertension.
  • A significant 9% of patients discontinued treatment due to adverse effects.
  • More RCTs are required to determine if treatment benefits outweigh harms in this prevalent population.