Do antihypertensive medication improve outcomes in patients without hypertension?

January 01, 0001

Do antihypertensive medication improve outcomes in patients without hypertension?

Studies have suggested that cardiovascular risk from increasing blood pressure starts at levels below the diagnostic threshold for hypertension. These US researchers examined whether antihypertensive treatment has a benefit on cardiovascular disease (CVD) events and all-cause mortality among persons without clinically defined hypertension but known diabetes or CVD. They performed a meta-analysis of 25 studies that met inclusion criteria.

The researchers found: "Compared with controls, participants receiving antihypertensive medications had a pooled relative risk of 0.77 for stroke, 0.80 for myocardial infarction (MI), 0.71 for congestive heart failure (CHF), 0.85 for composite CVD events, 0.83 for CVD mortality, and 0.87 for all-cause mortality from random-effects models. The corresponding absolute risk reductions per 1000 persons were -7.7 for stroke, -13.3 for MI, -43.6 for CHF events, -27.1 for composite CVD events, -15.4 for CVD mortality, and -13.7 for all-cause mortality. Results did not differ according to trial characteristics or subgroups defined by clinical history."

The researchers concluded: "Among patients with clinical history of CVD but without hypertension, antihypertensive treatment was associated with decreased risk of stroke, CHF, composite CVD events, and all-cause mortality. Additional randomized trial data are necessary to assess these outcomes in patients without CVD clinical recommendations"

Use of antihypertensives in high-risk patients without hypertension may decrease cardiovascular risk.

For the full abstract, click here.

JAMA 305(9):913-922, 2 March 2011
© 2011 American Medical Association
Antihypertensive Treatment and Secondary Prevention of Cardiovascular Disease Events Among Persons Without Hypertension. Angela M. Thompson, Tian Hu, Carrie L. Eshelbrenner, Kristi Reynolds, Jiang He, Lydia A. Bazzano.

Category: K. Circulatory. Keywords: antihypertensives, hypertension, cardiovascular risk, mortality, stroke, meta-analysis, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 22 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.