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Hypertension trial results: consensus and conflicts
1Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
Insights
Treating mild hypertension in adults under 60 significantly reduces stroke risk by 40%. For older individuals, hypertension treatment offers greater benefits by also lowering coronary events.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Hypertension management is crucial for preventing cardiovascular and cerebrovascular events.
- The benefits of treating mild hypertension, particularly in younger populations, require careful evaluation.
- Declining stroke mortality rates may be influenced by factors beyond hypertension treatment.
Purpose of the Study:
- To evaluate the benefits of hypertension treatment in different age groups.
- To quantify the impact of hypertension management on stroke and coronary event reduction.
Main Methods:
- Analysis of data from clinical trials, including the MRC trial.
- Assessment of patient-years of treatment required to prevent adverse events.
Main Results:
- Hypertension treatment reduces stroke by approximately 40% in patients under 60.
- In older patients, treatment yields greater absolute benefits due to higher event rates and reduction of coronary events.
Conclusions:
- Hypertension treatment is clearly beneficial in severe and accelerated cases.
- While beneficial for younger individuals, the number of patients needed to prevent a stroke is substantial.
- Older patients experience greater absolute benefits from hypertension treatment, including reduced coronary events.
Abstract:
In severe and accelerated hypertension the benefits of treatment are clearcut. In patients < 60 years of age with mild hypertension the main benefit is reduction of stroke by about 40%. The death rate from stroke is declining in many affluent countries for reasons which can only be partly explained by mass treatment of hypertension. In the MRC trial in patients < 60 years old it took 2500 patient/years of treatment to save one stroke. If the number of strokes is declining for other reasons the number of patient/years to save one stroke may be increasing. In older patients the absolute benefit is greater because they suffer more stroke events and because treatment also reduces coronary events.