Low Clinical Utility Seen in Treating Low-Risk, Mild Hypertension


Large British study shows no outcome benefit, more adverse events.

Antihypertensive treatment for lower-risk patients with mild hypertension was associated with more adverse events but no better outcomes in a longitudinal cohort study.

Among treatment-naive people with a blood pressure in the 140/90 to 159/99 mm Hg range and no history of cardiovascular disease or risk factors for it, overall mortality during was 4.08% (95% CI 3.80%-4.37%) among those who didn’t start on antihypertensives and 4.49% (95% CI 4.20%-4.80%) among those who did during 5.8 years of follow-up.

That 2% excess risk with treatment wasn’t significant, but there were significant increased risks of hypotension, syncope, electrolyte abnormalities, and acute kidney injury, reported James Sheppard, PhD, of University of Oxford in England, and colleagues, in JAMA Internal Medicine.

There was also no evidence of a relationship when looking at antihypertensive treatment and cardiovascular disease (HR 1.09, 95% CI 0.95-1.25).

The 2017 national guidelines recommend pharmacologic intervention starting at 130/80 mm Hg for high-risk patients and for all individuals regardless of risk with a blood pressure of 140/90 mm Hg or higher.

However, “these recommendations are considered to be controversial particularly with regard to treatment of people with low CVD risk and mild hypertension (ie, sustained blood pressure of 140/90-159/99 mm Hg), for whom there is a lack of clinical trial evidence to support initiation of pharmacologic treatment,” the researchers wrote.

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