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BP drugs reduced risk for CV events, death in patients with mild hypertension
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Pharmacologic BP reduction was associated with reduced risk for CV events and death in patients with mild hypertension and no evidence of CVD, according to results of a systematic review.
Researchers analyzed 13 studies that included 15,266 patients with grade 1 hypertension, defined as systolic BP 140 mm Hg to 159 mm Hg and diastolic BP 90 mm Hg to 99 mm Hg, and no evidence of CVD. All patients in those trials were randomly assigned to an antihypertensive drug and more intense BP-lowering regimen or to placebo and a less intense BP-lowering regimen. The following outcomes were analyzed: a composite of stroke, nonfatal MI/CHD death, HF and CV death; stroke, nonfatal MI/CHD death, HF and CV death individually; and total deaths. Median follow-up was 4.4 years in the Blood Pressure Lowering Treatment Trialists’ Collaboration studies and 4 to 5 years in other studies.
Johan Sundström
Johan Sundström, MD, PhD, and colleagues determined that the average reduction for the active groups in the studies was 3.6 mm Hg for systolic BP and 2.4 mm Hg for diastolic BP.
Over 5 years, the active groups had lower odds for stroke (OR=0.72; 95% CI, 0.55-0.94), CV death (OR=0.75; 95% CI, 0.57-0.98) and all-cause death (OR=0.78; 95% CI, 0.67-0.92). The active groups also had a trend toward lower odds for total CV events (OR=0.86; 95% CI, 0.74-1.01), coronary events (OR=0.91; 95% CI, 0.74-1.12) and HF (OR=0.8; 95% CI, 0.57-1.12), according to the researchers.
Total withdrawals were similar between the active and control groups, although withdrawals for adverse events were more common in the active groups, Sundström, from the department of medical sciences and the Uppsala Clinical Research Center, Uppsala University, Sweden, and colleagues wrote.
Although modest BP reductions were achieved, moderate numbers of events were recorded and confidence intervals were wide, according to the researchers. “The findings suggest that [BP] reduction is likely to provide benefit among patients with grade 1 hypertension and that these benefits could be substantial, particularly among patients at elevated absolute [CV] risk,” Sundström and colleagues wrote.
The findings are consistent with those of large-scale trials of BP reduction in patients with higher BPs and/or preexisting CVD, they wrote.
Disclosure: See the full study for a list of funding sources and the researchers’ relevant financial disclosures.
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