Antihypertensive drugs of no benefit in mild hypertension: JAMA

UK: Antihypertensive drugs do not provide protection against cardiovascular disease and death in low-risk patients with mild hypertension, according to a new study published in the journal JAMA Internal Medicine.

James P. Sheppard, University of Oxford, Oxford, United Kingdom, and colleagues conducted the study to examine whether antihypertensive treatment is associated with a low risk of mortality and cardiovascular disease (CVD) in low-risk patients with mild hypertension.

"Evidence to support the initiation of pharmacologic treatment in low-risk patients with mild hypertension is inconclusive, with previous trials underpowered to demonstrate benefit. Clinical guidelines across the world are contradictory," the authors write.

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In this longitudinal cohort study, the authors extracted data from the Clinical Practice Research Datalink, from January 1, 1998, through September 30, 2015, for patients aged 18 to 74 years who had mild hypertension (untreated blood pressure of 140/90-159/99 mm Hg) and no previous treatment. Anyone with a history of CVD or CVD risk factors were excluded. Patients exited the cohort if follow-up records became unavailable or they experienced an outcome of interest.

The rates of mortality, CVD, and adverse events among patients prescribed antihypertensive treatment at baseline, compared with those who were not prescribed such treatment, using Cox proportional hazards regression.

A total of 19 143 treated patients (mean [SD] age, 54.7 [11.8] years; 10 705 [55.9%] women; 10 629 [55.5%] white) were matched to 19 143 similar untreated patients (mean [SD] age, 54.9 [12.2] years; 10 631 [55.5%] female; 10 654 [55.7%] white).

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Key Findings:

• During a median follow-up period of 5.8 years (interquartile range, 2.6-9.0 years), no evidence of an association was found between antihypertensive treatment and mortality (hazard ratio [HR], 1.02; 95% CI, 0.88-1.17) or between antihypertensive treatment and CVD (HR, 1.09; 95% CI, 0.95-1.25).


• Treatment was associated with an increased risk of adverse events, including hypotension (HR, 1.69; 95% CI, 1.30-2.20; number needed to harm at 10 years [NNH₁₀], 41), syncope (HR, 1.28; 95% CI, 1.10-1.50; NNH₁₀, 35), electrolyte abnormalities (HR, 1.72; 95% CI, 1.12-2.65; NNH_10,111), and acute kidney injury (HR, 1.37; 95% CI, 1.00-1.88; NNH₁₀, 91).

This prespecified analysis found no evidence to support guideline recommendations that encourage initiation of treatment in patients with low-risk mild hypertension. There was evidence of an increased risk of adverse events, which suggests that physicians should exercise caution when following guidelines that generalize findings from trials conducted in high-risk individuals to those at lower risk.

For further reference follow the link: 10.1001/jamainternmed.2018.4684