Pharmacotherapy for Mild Hypertension

Overview

Journal Cochrane Database Syst Rev

Publisher Wiley

Specialties General Medicine
Health Services

Date 2012 Aug 17

PMID 22895954

Citations 67

Authors

Diana Diao

James M Wright

David K Cundiff

Francois Gueyffier

Affiliations

Soon will be listed here.

Abstract

Background: People with no previous cardiovascular events or cardiovascular disease represent a primary prevention population. The benefits and harms of treating mild hypertension in primary prevention patients are not known at present. This review examines the existing randomised controlled trial (RCT) evidence.

Objectives:

Primary Objective: To quantify the effects of antihypertensive drug therapy on mortality and morbidity in adults with mild hypertension (systolic blood pressure (BP) 140-159 mmHg and/or diastolic BP 90-99 mmHg) and without cardiovascular disease.

Search Methods: We searched CENTRAL (2011, Issue 1), MEDLINE (1948 to May 2011), EMBASE (1980 to May 2011) and reference lists of articles. The Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness (DARE) were searched for previous reviews and meta-analyses of anti-hypertensive drug treatment compared to placebo or no treatment trials up until the end of 2011.

Selection Criteria: RCTs of at least 1 year duration.

Data Collection And Analysis: The outcomes assessed were mortality, stroke, coronary heart disease (CHD), total cardiovascular events (CVS), and withdrawals due to adverse effects.

Main Results: Of 11 RCTs identified 4 were included in this review, with 8,912 participants. Treatment for 4 to 5 years with antihypertensive drugs as compared to placebo did not reduce total mortality (RR 0.85, 95% CI 0.63, 1.15). In 7,080 participants treatment with antihypertensive drugs as compared to placebo did not reduce coronary heart disease (RR 1.12, 95% CI 0.80, 1.57), stroke (RR 0.51, 95% CI 0.24, 1.08), or total cardiovascular events (RR 0.97, 95% CI 0.72, 1.32). Withdrawals due to adverse effects were increased by drug therapy (RR 4.80, 95%CI 4.14, 5.57), ARR 9%.

Authors' Conclusions: Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs. Treatment caused 9% of patients to discontinue treatment due to adverse effects. More RCTs are needed in this prevalent population to know whether the benefits of treatment exceed the harms.

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References

. Initial results of the Australian Therapeutic Trial in mild hypertension: Report by the Management Committee. Clin Sci (Lond). 1979; 57 Suppl 5:449s-452s. View

Holme I, Helgeland A, Hjermann I, Leren P, Mogensen S . Correlates of blood pressure change in middle-aged male mild hypertensives: results from the untreated control group in the Oslo hypertension trial. The Oslo Study. Am J Epidemiol. 1988; 127(4):742-52. DOI: 10.1093/oxfordjournals.aje.a114855. View

Helgeland A, Hjermann I, Holme I, Leren P . Serum triglycerides and serum uric acid in untreated and thiazide-treated patients with mild hypertension. The Oslo study. Am J Med. 1978; 64(1):34-8. DOI: 10.1016/0002-9343(78)90177-8. View

Abernethy J . The Australian therapeutic trial in mild hypertension. Hypertension. 1984; 6(5):774-6. DOI: 10.1161/01.hyp.6.5.774. View

Weiler P, Camel G, Chiappini M, Greenlick M, Hughes G, Luhr J . Systolic Hypertension of the Elderly Program (SHEP). Part 9: Behavioral characteristics. Hypertension. 1991; 17(3 Suppl):II152-61. DOI: 10.1161/01.hyp.17.3_suppl.ii152. View

Wassertheil-Smoller S, Fann C, Allman R, Black H, Camel G, Davis B . Relation of low body mass to death and stroke in the systolic hypertension in the elderly program. The SHEP Cooperative Research Group. Arch Intern Med. 2000; 160(4):494-500. DOI: 10.1001/archinte.160.4.494. View

Newman A, Tyrrell K, Kuller L . Mortality over four years in SHEP participants with a low ankle-arm index. J Am Geriatr Soc. 1997; 45(12):1472-8. DOI: 10.1111/j.1532-5415.1997.tb03198.x. View

Hawkins C . Isolated Systolic Hypertension, Morbidity, and Mortality: The SHEP Experience. Am J Geriatr Cardiol. 1993; 2(5):25-27. View

Helgeland A, Leren P . Oslo study: treatment of mild hypertension. A five-year controlled drug study. Nephron. 1987; 47 Suppl 1:108-10. DOI: 10.1159/000184565. View

10.

. The Australian therapeutic trial in mild hypertension. Report by the Management Committee. Lancet. 1980; 1(8181):1261-7. View

11.

Davis B, Wittes J, Pressel S, BERGE K, Hawkins C, LAKATOS E . Statistical considerations in monitoring the Systolic Hypertension in the Elderly Program (SHEP). Control Clin Trials. 1993; 14(5):350-61. DOI: 10.1016/0197-2456(93)90051-e. View

12.

Applegate W, Davis B, Black H, Smith W, Miller S, BURLANDO A . Prevalence of postural hypotension at baseline in the Systolic Hypertension in the Elderly Program (SHEP) cohort. J Am Geriatr Soc. 1991; 39(11):1057-64. DOI: 10.1111/j.1532-5415.1991.tb02869.x. View

13.

. Course of blood pressure in mild hypertensives after withdrawal of long term antihypertensive treatment. Medical Research Council Working Party on Mild Hypertension. Br Med J (Clin Res Ed). 1986; 293(6553):988-92. PMC: 1341775. DOI: 10.1136/bmj.293.6553.988. View

14.

. The effect of treatment on mortality in "mild" hypertension: results of the hypertension detection and follow-up program. N Engl J Med. 1982; 307(16):976-80. DOI: 10.1056/NEJM198210143071603. View

15.

Abernethy J . The need to treat mild hypertension. Misinterpretation of results from the Australian trial. JAMA. 1986; 256(22):3134-7. View

16.

Vogt T, Schron E, Pressel S, EDDLEMAN E, Miller S, Stamler J . Systolic Hypertension in the Elderly Program (SHEP). Part 3: Sociodemographic characteristics. Hypertension. 1991; 17(3 Suppl):II24-34. DOI: 10.1161/01.hyp.17.3_suppl.ii24. View

17.

Wassertheil-Smoller S, Applegate W, Berge K, Chang C, Davis B, Grimm Jr R . Change in depression as a precursor of cardiovascular events. SHEP Cooperative Research Group (Systoloc Hypertension in the elderly). Arch Intern Med. 1996; 156(5):553-61. View

18.

. Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ. 1992; 304(6824):405-12. PMC: 1995577. DOI: 10.1136/bmj.304.6824.405. View

19.

Black H, UNGER D, BURLANDO A, Wright J, Pressel S, Allen R . Systolic Hypertension in the Elderly Program (SHEP). Part 6: Baseline physical examination findings. Hypertension. 1991; 17(3 Suppl):II77-101. DOI: 10.1161/01.hyp.17.3_suppl.ii77. View

20.

. MRC trial of treatment of mild hypertension: principal results. Medical Research Council Working Party. Br Med J (Clin Res Ed). 1985; 291(6488):97-104. PMC: 1416260. DOI: 10.1136/bmj.291.6488.97. View