• DOI:10.7326/M14-0773
• Corpus ID: 46553658

Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis.

@article{Sundstrm2015EffectsOB,
  title={Effects of blood pressure reduction in mild hypertension: a systematic review and meta-analysis.},
  author={Johan Sundstr{\"o}m and Hisatomi Arima and Rod Jackson and Fiona M Turnbull and Kazem Rahimi and John Chalmers and Mark Woodward and Bruce Neal},
  journal={Annals of internal medicine},
  year={2015},
  volume={162 3},
  pages={
          184-91
        }
}

• J. Sundström, H. Arima, +5 authors B. Neal
• Published 3 February 2015
• Medicine
• Annals of internal medicine

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.