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Is Treating Mild Hypertension Beneficial?

A recent study found no evidence supporting the treatment of mild hypertension in low-risk patients.
Previous studies have not been able to determine the benefits of treatment of low-risk patients with mild hypertension. To further explore this issue, researchers conducted a longitudinal cohort study involving 19,143 patients, aged 18 to 74, with mild hypertension (untreated blood pressure [BP] of 140/90-159/99 mm Hg) and no previous treatment, as well as 19,143 controls. Patients with a history of cardiovascular disease (CVD) or CVD risk factors were excluded.
Over a median follow-up of 5.8 years, the researchers observed no evidence of an association between antihypertensive treatment and mortality (hazard ratio [HR] 1.02) or CVD (HR 1.09). Treatment was, however, associated with an increased risk of adverse events, including hypotension (HR 1.69), syncope (HR 1.28), electrolyte abnormalities (HR 1.72), and acute kidney injury (HR 1.37).
“These observational data provide no evidence that antihypertensive treatment is associated with reduced mortality or rates of CVD among low-risk patients with mild hypertension. Such data may be subject to bias from unmeasured confounding but suggest that caution should be exercised when considering treatment in this population.”

Sheppard JP, Stevens S, Stevens R, et al. Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension [published online October 29, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.4684