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

  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},
  volume={162 3},
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… 

Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis

  • Amanda Larry Ale Folkert W Nigel S Eivind Henry Frank P J Adler Agodoa Algra Asselbergs Beckett Berge Black A. Adler Jiguang Wang
  • Medicine
    The Lancet
  • 2021

Effectiveness of blood pressure-lowering drug treatment by levels of absolute risk: post hoc analysis of the Australian National Blood Pressure Study

It is confirmed that the benefit of treatment was substantial only in the high-risk tertile, reaffirming the rationale of treating elevated blood pressure in the setting of all risk factors rather than in isolation.

Management of mild hypertension in adults

Lifestyle modifications for reducing blood pressure are appropriate for all patients and may be recommended while delaying drug treatment for those at lower absolute levels of cardiovascular disease risk, although net benefits are greater for patients at higherabsolute levels ofCardiovascular disease risk.

Randomized controlled trials of blood pressure lowering in hypertension: a critical reappraisal.

The results of these meta-analyses provide further support to current hypertension treatment guidelines by showing that BP lowering can significantly reduce major cardiovascular outcomes largely independent of the agents used, significant risk reduction is found at all hypertension grades (stages).

A Randomized Trial of Intensive versus Standard Blood-Pressure Control.

Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure target of less than 120 mm Hg, as compared with less than 140 mm HG, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group.

Review: In patients with mild hypertension and no CV disease, BP-lowering drugs reduce stroke and mortality

  • M. Tanner
  • Medicine
    Annals of Internal Medicine
  • 2015
In patients with mild hypertension and no diagnosed cardiovascular disease, blood pressurelowering drugs (vs placebo or less-intensive regimens) reduce stroke and mortality.

Pharmacotherapy for hypertension in adults aged 18 to 59 years.

The quality of evidence for all outcomes was downgraded and very low quality evidence from three studies showed that withdrawals due to adverse events were higher with drug therapy than with placebo or untreated control.

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

This prespecified analysis found no evidence to support guideline recommendations that encourage initiation of treatment in patients with low-risk mild hypertension, and there was evidence of an increased risk of adverse events, which suggests that physicians should exercise caution when following guidelines that generalize findings from trials conducted in high-risk individuals to those at lower risk.

Legacy effect of delayed blood pressure lowering drug treatment in middle-aged adults with mildly elevated blood pressure: systematic review and meta-analysis

No clinically adverse ‘legacy effect’ on mortality or major CVD event from not treating middle-aged adults at a systolic BP threshold of 140 mmHg or over is shown, which may allay concerns that early treatment of elevated systol BP is necessary to prevent CVD events in primary prevention populations.



Pharmacotherapy for mild hypertension.

Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension have not been shown to reduce mortality or morbidity in RCTs.

Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies

All the classes of blood pressure lowering drugs have a similar effect in reducing CHD events and stroke for a given reduction in blood pressure, indicating that the benefit is explained by blood pressure reduction itself.

The world health organization—International society of hypertension blood pressure lowering treatment trialists’ collaboration: Prospective collaborative overviews of major randomized trials of blood pressure-lowering treatments

Clear evidence shows that decreasing blood pressure reduces risks for major cardiovascular events in patients with hypertension. However, there is considerable uncertainty about the separate effects

Effects of different blood pressure-lowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials.

These overviews showed that the short- to-medium-term effects on major cardiovascular events of the BP-lowering regimens studied were broadly comparable for patients with and without diabetes.

Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes.

Intensive BP control in normotensive type 2 diabetic patients: (1) slowed the progression to incipient and overt diabetic nephropathy; (2) decreased the progression of diabetic retinopathy; and (3) diminished the incidence of stroke.

Effects of losartan vs candesartan in reducing cardiovascular events in the primary treatment of hypertension

There was no difference in blood pressure reduction when comparing the losartan and candesartan groups during follow-up suggesting that other mechanisms related to different pharmacological properties of the drugs may explain the divergent clinical outcomes.

Blood pressure-dependent and independent effects of agents that inhibit the renin–angiotensin system

There are similar blood pressure-dependent effects of ACEI and ARB for the risks of stroke, CHD and heart failure and for ACEI, but not ARB, there is evidence ofBlood pressure-independent effects on the risk of major coronary disease events.