The community-based randomized trials of pharmacologic treatment of mild-to-moderate hypertension

The value of pharmacologic treatment of mild-to-moderate hypertension remains controversial despite the availability of data from eight community-based randomized trials including over 34,000 subjects with entry diastolic blood pressures ranging from 85 to 120 mmHg. To obtain more reliable estimates of the effects of treatment, the authors conducted an overview of the data from all of these individual trials, and they found a significant 18% reduction in vascular mortality among subjects allocated to treatment, due chiefly to reductions in fatal stroke and myocardial infarction. Subjects allocated to treatment experienced highly significant reductions of approximately 40% in all stroke (typical odds ratio = 0.60, 95% confidence interval = 0.51-0.71) and fatal stroke (0.58, 0.44-0.77). For myocardial infarction, the proportional reductions were much smaller than those for stroke and were 9% for all and 8% for fatal events. While suggestive of protective effects, the typical odds ratios did not achieve statistical significance for either all (0.91, 0.82-1.01) or for fatal myocardial infarction (0.92, 0.78-1.08). This overview demonstrates a significant benefit of pharmacologic treatment of mild-to-moderate hypertension on vascular mortality and on all as well as fatal stroke. It also suggests possible benefits of treatment on all and fatal myocardial infarction which should be investigated further.