'Little Evidence' Supporting Mild Hypertension Drug Treatment

Peter Russell

October 30, 2018

Advice to treat cases of low-risk mild high blood pressure with antihypertensive medication was not supported by clinical evidence, a study found.

Guidelines for treating and managing adult hypertension are currently being reviewed by the National Institute for Health and Care Excellence (NICE). As a general guide, high blood pressure is considered to be 140/90 mmHg or higher.

However, recent controversial US guidelines recommended lowering the treatment threshold. The guidelines, drawn up by the American College of Cardiology/American Heart Association (ACC/AHA), recommended initiating pharmacologic treatment for high-risk patients with a blood pressure of130/80 mmHg or higher, and for all individuals with a blood pressure of 140/90 mmHg or higher regardless of risk.

Those guidelines would effectively shift US patients with stage 1 hypertension into the stage 2 hypertension category.

Study of UK Patients

Researchers from the universities of Oxford, Cambridge, and Birmingham set out to examine whether antihypertensive treatment was associated with a low risk of mortality and cardiovascular disease in low-risk patients with mild hypertension.

The observational study, published in the journal JAMA Internal Medicine , drew on medical records involving 38,286 UK patients from 1998 to 2015 with an average age of around 54. The patients had mild hypertension, defined by UK standards as stage 1: 140-159/90-99 mmHg. None of the participants had previously received treatment for their condition.

They compared patients who went on to be treated with antihypertensive medication with those who were not.

'Little Evidence of Benefit'

During a median follow-up period of 5.8 years, the researchers identified no evidence of an association between antihypertensive treatment and mortality rates, or between antihypertensive treatment and cardiovascular disease.

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

The authors concluded: "The findings suggest that physicians should be cautious when initiating treatment in low-risk patients with mild hypertension, particularly because such an approach may affect millions of individuals with little evidence of benefit."

Dr James Sheppard from Oxford University's Nuffield Department of Primary Care Health Sciences, who led the study, said: "This suggests that doctors should be cautious when considering hypertension treatment in this group and 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."

The researchers said that the results should be treated with caution, given the observational nature of their investigation. They called for large-scale clinical trials to ensure that guidelines on treating hypertension were based on the best quality evidence.

Know Your Numbers

The British Heart Foundation (BHF) said doctors and patients should discuss treatment options. Emily McGrath, the BHF's senior cardiac nurse, commented: "High blood pressure causes damage to the heart and blood vessels, putting you at risk of a potentially fatal heart attack or stroke.

"Knowing your blood pressure will help you get the right advice and medication you need to bring it under control.

"If your blood pressure is only slightly raised, medication may not be right for you. Chat to your GP about other ways to lower your blood pressure, which may include simple lifestyle changes."

The study was funded by the Medical Research Council and supported by the National Institute for Health Research.

Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension, Sheppard J, et al, JAMA Internal Medicine. Paper.


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