Pharmacotherapy for mild hypertension

There is insufficient evidence on benefits of antihypertensive drugs for mild hypertension (systolic blood pressure of 140 - 159 mmHg or diastolic blood pressure 90 - 99 mmHg).

The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment), by imprecise results (few outcome events), and by indirectness (differences between the outcomes of interest and those reported: lack of long-term data; and differences between the interventions of interest and those studied: antihypertensive drugs widely in use nowadays were not studied).

Summary

A Cochrane review included 4 studies with a total of 8 912 subjects. Participants had mild hypertension defined as a systolic blood pressure of 140 - 159 mmHg or diastolic blood pressure 90 - 99 mmHg, and no evidence of cardiovascular disease at baseline. Mean age of participants in the included studies varied from 37.5 to 72 years. 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 to 1.15; 4 studies, n=8 912). Furthermore, antihypertensive treatment did not significantly reduce total stroke (RR 0.51, 95% CI 0.24 to 1.08), total coronary heart disease (RR 1.12, 95% CI 0.80 to 1.57) or total cardiovascular events (RR 0.97, 95% CI 0.72 to 1.32; 3 studies, n=7 080). Withdrawals due to adverse effects were increased by drug therapy (RR 4.80, 95% CI 4.14 to 5.57; absolute risk increase 9%).

Clinical comments

Included studies were primary prevention trials, but there was no data on total cardiovascular risk of the participants.

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Ədəbiyyat

1. Diao D, Wright JM, Cundiff DK et al. Pharmacotherapy for mild hypertension. Cochrane Database Syst Rev 2012;(8):CD006742.