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Author Spotlight: Exploring Huotan Jiedu Tongluo Decoction as an Antihypertensive Drug
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Pharmacotherapy for mild hypertension.

Dominic Wang1, James M Wright2, Stephen P Adams2

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Initiating antihypertensive pharmacotherapy for mild hypertension shows no clear benefit for mortality or cardiovascular events. While stroke risk may decrease, withdrawal due to adverse effects (WDAEs) increases, with low-certainty evidence overall.

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Area of Science:

  • Cardiology and Hypertension Research
  • Evidence-Based Medicine and Systematic Reviews
  • Pharmacotherapy Efficacy and Safety

Background:

  • Mild hypertension (systolic BP 140-159 mmHg or diastolic BP 90-99 mmHg) without cardiovascular disease presents an uncertain landscape for pharmacotherapy initiation.
  • Previous reviews indicated no significant differences in mortality, cardiovascular events, or adverse effects with antihypertensive treatment in this population.
  • Conflicting study results necessitate an updated assessment of initiating antihypertensive pharmacotherapy for primary prevention in mild hypertension.

Purpose of the Study:

  • To reassess the efficacy and risks of initiating antihypertensive pharmacotherapy versus placebo or no treatment in adults with untreated mild hypertension.
  • Primary objective: Evaluate the impact on all-cause mortality and total cardiovascular events (stroke, myocardial infarction, heart failure).
  • Secondary objectives: Assess effects on stroke incidence, coronary heart disease, and withdrawal due to adverse effects (WDAEs).

Main Methods:

  • Updated systematic review including randomized controlled trials (RCTs) of at least one-year duration.
  • Searched multiple databases (Cochrane Hypertension, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, WHO ICTRP) up to June 2024.
  • Assessed risk of bias using Cochrane's RoB 1 tool and certainty of evidence with GRADE; synthesized data using Mantel-Haenszel fixed-effect model.

Main Results:

  • Five trials (9124 participants) compared antihypertensives to placebo/no treatment.
  • Antihypertensives showed little to no reduction in all-cause mortality (low-certainty), total cardiovascular events (low-certainty), or coronary heart disease (low-certainty).
  • A potential decrease in stroke risk (low-certainty) was observed, alongside a significant increase in withdrawal due to adverse effects (WDAEs) (low-certainty).

Conclusions:

  • Initiating antihypertensive monotherapy or step-up therapy for mild, untreated hypertension without pre-existing cardiovascular disease may not offer significant benefits for mortality or major cardiovascular events.
  • A possible reduction in stroke risk exists, but this is counterbalanced by a notable increase in adverse events leading to treatment withdrawal.
  • The overall certainty of evidence for these outcomes is low, highlighting the need for cautious interpretation and further research in this area.