Antihypertensives offer 'no benefit' in mild hypertension

Researchers suggest discussing lifestyle changes as an alternative to drug therapy

Antihypertensive drugs do not protect low-risk patients with mild hypertension against cardiovascular disease and death, according to a large UK study.

Evidence to support starting drug therapy to treat hypertension in this cohort is "inconclusive, with previous trials underpowered to demonstrate benefit," the authors say in JAMA Internal Medicine.

The researchers reviewed e-health records from a UK database to assess the benefits and harms of antihypertensive therapy in low-risk patients, defined as having three consecutive untreated BP readings of 140/90-159/99mmHg within 12 months.

The cohort included 19,143 adults prescribed antihypertensive treatment at baseline and 19,143 matched adults who were not prescribed antihypertensives.

In both cohorts, the mean age was around 55 and just over half were women.

During an average follow-up of close to six years, 1641 people died. Overall mortality was 4.08% in the untreated group and 4.49% in the treated group.

There was no significant association between antihypertensive treatment and cardiovascular disease, the study reported.

No associations emerged for stroke, myocardial infarction, heart failure or non-MI acute coronary syndrome.

However, antihypertensive treatment was associated with an increased risk of adverse events, including hypotension, syncope, electrolyte abnormalities and acute kidney injury.

Exposure to antihypertensives was based on prescriptions written by a primary care physician, and it was not possible to determine whether this prescription was subsequently filled or whether patients actually took the medication as prescribed.

"We found that, contrary to the latest guideline recommendations, there was no evidence of any benefit to treating patients with low-risk mild hypertension," said lead author Dr James Sheppard (PhD), from the University of Oxford.

"This suggests that doctors should be cautious when considering hypertension treatment in this group. We would therefore encourage a conversation between a patient and their doctor to decide the best way to treat the condition.

"Younger patients in particular may prefer to adopt lifestyle changes to reduce their blood pressure, rather than committing to taking antihypertensive drugs for many years.”

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More information: JAMA Internal Medicine 2018

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