Does Antihypertensive Therapy Reduce CVD Risk in Low-Risk Patients With Mild Hypertension?

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Treatment of low-risk patients with mild hypertension with antihypertensive medication should be done with caution.
Treatment of low-risk patients with mild hypertension with antihypertensive medication should be done with caution.

No benefits were observed when low-risk patients with mild hypertension took antihypertensive medication, according to a study published in JAMA Internal Medication.

Researchers retrospectively analyzed data from the Clinical Practice Research Datalink to determine the impact on mortality, cardiovascular disease, and the development of adverse events when treating patients with low-risk mild hypertension. Medical records and codes were used to collect data on demographics, medical history, blood pressure readings, and hospital mortality causes.

Low-risk patients were identified by exclusion. Anyone with a known history of cardiovascular disease, left ventricular hypertrophy, atrial fibrillation, diabetes, chronic kidney disease, or family history of premature heart disease were not included in data analysis.

The 19,143 low-risk patients with mild hypertension who were treated with antihypertensive medications were matched by age, gender, and ethnicity to 19,143 untreated patients with low-risk mild hypertension. The groups had no significant baseline characteristics differences other than diastolic blood pressure, cardiovascular disease risk, and alcohol consumption, but these differences were not clinically significant.

During the follow-up time frame, 41.6% of the untreated arm were prescribed antihypertensive medication. There was no difference between the two arms in regards to time to death, but there was a mortality rate of 4.08% in the control arm and 4.49% in the treated arm, with a risk difference of 0.41% (95% CI, 0.02%-0.85%).

There were also no associations between cardiovascular disease, stroke, myocardial infarction, or heart failure and the use of antihypertensive medication, but there was a significant association between treatment and time to an adverse event, such as hypotension (P <.001), syncope (P =.002), electrolyte abnormalities (P =.01), and acute kidney injury (P =.048).

Future studies need to increase sample size to reduce confidence intervals for more reliable results, attempt to reduce patient crossover into opposite treatment arms, and control for medications taken.

The researchers concluded that treatment of low-risk patients presenting with mild hypertension with antihypertensive medication should be done with caution, as adverse events are more likely than a reduction in the risk of mortality or cardiovascular disease.   

Reference

Sheppard JP, Stevens S, Stevens R, et al. Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension [published online October 29, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.4684

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