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

Sheppard JP, Stevens S, Stevens R, Martin U, Mant J, Hobbs FDR, McManus RJ. JAMA Intern Med. October 29, 2018. [CrossRef]

Evidence to support initiation of pharmacologic treatment in low-risk patients with mild hypertension is inconclusive, with previous trials underpowered to demonstrate benefit. Clinical guidelines across the world are contradictory. In this longitudinal cohort study, data were extracted from the Clinical Practice Research Datalink, from January 1, 1998, through September 30, 2015, for patients aged 18 to 74 years who had mild hypertension (untreated blood pressure of 140/90-159/99 mm Hg) and no previous treatment. A total of 19,143 treated patients were matched to 19,143 similar untreated patients. During a median follow-up period of 5.8 years, no evidence of an association was found between antihypertensive treatment and mortality. Treatment was associated with an increased risk of adverse events, including hypotension, syncope, electrolyte abnormalities, and acute kidney injury. The authors found no evidence to support guideline recommendations that encourage initiation of treatment in patients with low-risk mild hypertension but an increased risk of adverse events.