Blood pressure drugs likely to prevent stroke, death from mild hypertension

Pharmacologic treatment of blood pressure may prevent major cardiovascular events and death in patients with uncomplicated stage 1 hypertension, according to a systematic review.

Blood pressure-lowering therapy tended to lead to reductions in stroke, cardiovascular deaths, and total deaths in patients with systolic blood pressure of 140 to 159 mm Hg and/or diastolic blood pressure of 90 to 99 mm Hg, reported the systemic review and meta-analysis that were published online Dec. 22 by Annals of Internal Medicine.

The analysis included the BPLTTC (Blood Pressure Lowering Treatment Trialists' Collaboration), well as trials identified from a previous review and electronic database searches. In total there were 15,266 patients with grade 1 hypertension without cardiovascular disease: 7,842 patients receiving active therapy and 7,424 control participants. Of these, 14,457 (95%) were from trials comparing a drug versus placebo, and 809 (5%) were from trials comparing a more intensive blood pressure-lowering regimen against a less intensive one. Mean patient age was 63 years in the active group and 64 years in the control group.

The average blood pressure reduction was about 3.6/2.4 mm Hg. Over 5 years, the treated patients had odds ratios of 0.86 (95% CI, 0.74 to 1.01) for total cardiovascular events, 0.72 (95% CI, 0.55 to 0.94) for strokes, 0.91 (95% CI, 0.74 to 1.12) for coronary events, 0.80 (95% CI, 0.57 to 1.12) for heart failure, 0.75 (95% CI, 0.57 to 0.98) for cardiovascular deaths, and 0.78 (95% CI, 0.67 to 0.92) for total deaths.

The researchers wrote, “The effective treatment of patients with blood pressures in the grade 1 hypertension range in the primary preventive setting is likely to reduce the risk for several important adverse health outcomes. As for other groups, the magnitude of the benefit depends primarily on the size of the blood pressure reduction achieved and the level of baseline risk.”

An accompanying editorial that addressed this study (and an accompanying systematic review for the U.S. Preventive Services Task Force) stated, “The fact that modest blood pressure reduction in this younger population without clinical cardiovascular disease significantly reduces hard clinical outcomes, such as stroke and death, shows promise for even greater absolute event reduction in higher-risk populations, such as older persons, those with cardiovascular disease, and high-risk racial or ethnic subgroups. This report also reinforces the tight correlation between blood pressure reduction in this blood pressure range and stroke reduction seen in other studies.”