Benefits and Harms of Antihypertensive Treatment in Low-Risk Patients With Mild Hypertension

Benefits and Harms of Antihypertensive Treatment in Low-Risk Patients With Mild Hypertension

(complete study on link)

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2708195


Key Points

Question Is antihypertensive treatment associated with lower risk for mortality and cardiovascular disease in patients with mild hypertension?

Findings In this study of electronic health records of 38 286 low-risk patients with mild hypertension, no evidence of an association was found between exposure to antihypertensive treatment and mortality or cardiovascular disease. There was evidence that treatment may be associated with an increased risk of adverse events, such as hypotension, syncope, and acute kidney injury.

Meaning 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.

“Benefits and Harms of Antihypertensive Treatment in Low-Risk Patients With Mild Hypertension”

British researchers reviewed long-term medical records of adults with mild hypertension. They defined that as blood pressure between 140/90 and 159/99 without medication.

More than 19,000 people taking blood pressure pills were compared to 19,000 other patients with similar blood pressure but not taking medicine. Those are decent numbers. During the nearly six-year follow-up period, they found no evidence that treatment prevents cardiovascular disease or death.
Drilling Down on the Data:

Death is the ultimate measure of treatment success or failure. In theory, treating mild hypertension should prolong life. And the envelope please.

There were a total of 1,641 deaths during the study. The control group that did not get medications had a mortality rate of 4.08%. The mortality rate in the group of patients being treated with drugs was 4.49%. There was no significant difference between the groups. In other words, the meds did not prolong life.

When it came to things like cardiovascular disease, heart attacks, strokes or heart failure, there were no significant differences. Again, the blood pressure meds did not improve cardiovascular health. That, by the way, is heretical!
The Harms of Treating Mild Hypertension:

The medications did have side effects, however, most notably low blood pressure, fainting, electrolyte imbalance and acute kidney injury.
The authors conclude:

“The present data provide no evidence to suggest that new ACC/AHA guidelines will reduce CVD [cardiovascular disease] events in low-risk patients with mild hypertension…Furthermore, we found that long-term antihypertensive treatment in clinical practice was associated with harm attributable to adverse events, such as hypotension, syncope [fainting], electrolyte abnormalities, and acute kidney injury, although electrolyte abnormalities and acute kidney injury were sensitive to the definition of high risk used in the sensitivity analyses. Physicians should therefore be cautious when initiating new treatment in this population, and patients should be made aware of the limited evidence of efficacy for treatment in low-risk individuals.”

https://www.peoplespharmacy.com/2018/11/01/the-pros-and-cons-of-treating-mild-hypertension/

I have marked these to read later Yoly, many thanks   .

All the best Jan

But think of the profits!

Yes a side effect especially in the elderly can be falls caused by orthostatic hypotension, ie. BP dropping too low. Malcolm Kendrick has been covering BP in his last two blog posts.