Clinician Article
Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis.
PMID: 25531552
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Family Medicine (FM)/General Practice (GP)Relevance - 6/7
Newsworthiness - 6/7 -
General Internal Medicine-Primary Care(US)Relevance - 6/7
Newsworthiness - 6/7 -
Internal MedicineRelevance - 6/7
Newsworthiness - 6/7 -
CardiologyRelevance - 6/7
Newsworthiness - 5/7
Abstract
BACKGROUND: Effects of blood pressure reduction in persons with grade 1 hypertension are unclear.
PURPOSE: To investigate whether pharmacologic blood pressure reduction prevents cardiovascular events and deaths in persons with grade 1 hypertension.
DATA SOURCES: Trials included in the BPLTTC (Blood Pressure Lowering Treatment Trialists' Collaboration) and trials identified from a previous review and electronic database searches.
STUDY SELECTION: Patients without cardiovascular disease with blood pressures in the grade 1 hypertension range (140 to 159/90 to 99 mm Hg) who were randomly assigned to an active (antihypertensive drug or more intensive regimen) or control (placebo or less intensive regimen) blood pressure-lowering regimen.
DATA EXTRACTION: Individual-patient data from BPLTTC trials and aggregate data from other trials were extracted. Risk of bias was assessed for all trials.
DATA SYNTHESIS: Individual-patient data involved 10 comparisons from trials where most patients had diabetes, and aggregate data involved 3 comparisons from trials of patients without diabetes. The average blood pressure reduction was about 3.6/2.4 mm Hg. Over 5 years, odds ratios were 0.86 (95% CI, 0.74 to 1.01) for total cardiovascular events, 0.72 (CI, 0.55 to 0.94) for strokes, 0.91 (CI, 0.74 to 1.12) for coronary events, 0.80 (CI, 0.57 to 1.12) for heart failure, 0.75 (CI, 0.57 to 0.98) for cardiovascular deaths, and 0.78 (CI, 0.67 to 0.92) for total deaths. Results were similar in secondary analyses. Withdrawal from treatment due to adverse effects was more common in the active groups.
LIMITATION: Blood pressure reductions and numbers of events were small.
CONCLUSION: Blood pressure-lowering therapy is likely to prevent stroke and death in patients with uncomplicated grade 1 hypertension.
PRIMARY FUNDING SOURCE: Swedish Heart-Lung Foundation, Swedish Research Council, Australian Research Council, and National Health and Medical Research Council of Australia.
Clinical Comments
Cardiology
The authors clearly pointed out the limitations of the study in its applicability given the wide confidence intervals. These data support treatment of grade 1 hypertension to prevent strokes.
Cardiology
Highly relevant in light of the ongoing confusion regarding the appropriate BP targets for older individuals.
Family Medicine (FM)/General Practice (GP)
Having a sense of the magnitude of absolute benefit from treating stage 1 HTN in primary care settings is important for shared decision-making.
General Internal Medicine-Primary Care(US)
More evidence that is consistent with previous studies.
Internal Medicine
This issue is dealt with many times each day by primary care physicians. This analysis potentially will be very helpful when making those clinical decisions. What I did not see in my brief scan of the article was any mention of the NNT or similar number (that is, how many people would need to be treated to prevent such-and-such an event) and anything about harms. As presented in the abstract, the RRR without any mention of harms most certainly communicates an overly rosy view of the intervention.
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