Are medications needed in patients with mild hypertension and no other cardiovascular disease?

Nowadays, patients with mild HTN and no other cardiovascular (CV) disease are treated with anti-hypertensive drugs despite there being no evidence (clinical trials) supporting this practice. This review put this practice into test, evaluating if medical therapy reduce the risk of death or CV events among these subjects. 

Cardiovascular (CV) diseases is a class of conditions that involve the heart and/or blood vessels. Hypertension (HTN; high blood pressure) is included in this group. HTN increase the risk for CV events, such as stroke and heart attack, and for other CV diseases, such as coronary heart disease (CAD; disease of the arteries supplying the heart). Treatment for HTN involves both lifestyle changes (i.e. exercise, and dietary changes, etc) and medications. Lifestyle changes were proven to reduce blood pressure and extend survival. However, anti-hypertensive drugs were tested upon heterogenous study groups, including both patients with severe HTN (over 160/100 mmHg) and previous CV events, and those with mild HTN (140-159 over 90-99 mmHg) and no other CV disease. For the last ones, medical therapy has not yet proven beneficial.

The present review examined whether anti-hypertensive drugs given to patients with mild HTN and no CV disease, reduce the risk of death and/or CV events (stroke, heart attack and heart failure). 

This study reviewed 4 trials with overall 8,914 participants who had mild HTN and no other CV disease. Patients were followed over 4 to 5 years after starting medication for HTN. Overall survival was not convincingly affected. In studies that evaluated CV events, the risk of CAD, heart attack or stoke was not convincingly affected (7,080 patients). On the other hand, about 9% of the patients discontinued therapy due to drug-related adverse events.

The trials reviewed herein showed no convincing evidence that medical therapy for patients with mild HTN and no other CV disease improves survival or reduce the risk of CV diseases and events. To support the current practice, larger trials performed on similar subjects are required. 

This review is controversial. The duration of follow-up (4-5 years) was too short to draw conclusions about survival and the development of CV disease. The trials' study groups were too small to show any statistical differences in the outcomes measured. 

If you are diagnosed with HTN, with no other known CV disease, ask your doctor whether you are candidate for anti-hypertensive drug therapy.