Cargando…
Pharmacotherapy for mild hypertension
BACKGROUND: People with no previous cardiovascular events or cardiovascular disease represent a primary prevention population. The benefits and harms of treating mild hypertension in primary prevention patients are not known at present. This review examines the existing randomized controlled trial (...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Associação Paulista de Medicina - APM
2013
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522316/ https://www.ncbi.nlm.nih.gov/pubmed/23338742 http://dx.doi.org/10.1590/S1516-31802012000600012 |
_version_ | 1785110332743614464 |
---|---|
author | Diao, Diana Wright, James M. Cundiff, David K. Gueyffier, Francois |
author_facet | Diao, Diana Wright, James M. Cundiff, David K. Gueyffier, Francois |
author_sort | Diao, Diana |
collection | PubMed |
description | BACKGROUND: People with no previous cardiovascular events or cardiovascular disease represent a primary prevention population. The benefits and harms of treating mild hypertension in primary prevention patients are not known at present. This review examines the existing randomized controlled trial (RCT) evidence. OBJECTIVE: Primary objective: To quantify the effects of antihypertensive drug therapy on mortality and morbidity in adults with mild hypertension (systolic blood pressure (BP) 140-159 mmHg and/or diastolic BP 90-99 mmHg) and without cardiovascular disease. METHODS: Search: We searched CENTRAL (2011, Issue 1), MEDLINE (1948 to May 2011), EMBASE (1980 to May 2011) and reference lists of articles. The Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness (DARE) were searched for previous reviews and meta-analyses of anti-hypertensive drug treatment compared to placebo or no treatment trials up until the end of 2011. Selection criteria: RCTs of at least 1 year duration. Data collection and analysis: The outcomes assessed were mortality, stroke, coronary heart disease (CHD), total cardiovascular events (CVS), and withdrawals due to adverse effects. MAIN RESULTS: Of 11 RCTs identified 4 were included in this review, with 8,912 participants. Treatment for 4 to 5 years with antihypertensive drugs as compared to placebo did not reduce total mortality (RR 0.85, 95% CI 0.63, 1.15). In 7,080 participants treatment with antihypertensive drugs as compared to placebo did not reduce coronary heart disease (RR 1.12, 95% CI 0.80, 1.57), stroke (RR 0.51, 95% CI 0.24, 1.08), or total cardiovascular events (RR 0.97, 95% CI 0.72, 1.32). Withdrawals due to adverse effects were increased by drug therapy (RR 4.80, 95% CI 4.14, 5.57), ARR 9%. AUTHORS’ CONCLUSIONS: Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs. Treatment caused 9% of patients to discontinue treatment due to adverse effects. More RCTs are needed in this prevalent population to know whether the benefits of treatment exceed the harms. |
format | Online Article Text |
id | pubmed-10522316 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Associação Paulista de Medicina - APM |
record_format | MEDLINE/PubMed |
spelling | pubmed-105223162023-09-27 Pharmacotherapy for mild hypertension Diao, Diana Wright, James M. Cundiff, David K. Gueyffier, Francois Sao Paulo Med J Cochrane Highlights BACKGROUND: People with no previous cardiovascular events or cardiovascular disease represent a primary prevention population. The benefits and harms of treating mild hypertension in primary prevention patients are not known at present. This review examines the existing randomized controlled trial (RCT) evidence. OBJECTIVE: Primary objective: To quantify the effects of antihypertensive drug therapy on mortality and morbidity in adults with mild hypertension (systolic blood pressure (BP) 140-159 mmHg and/or diastolic BP 90-99 mmHg) and without cardiovascular disease. METHODS: Search: We searched CENTRAL (2011, Issue 1), MEDLINE (1948 to May 2011), EMBASE (1980 to May 2011) and reference lists of articles. The Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness (DARE) were searched for previous reviews and meta-analyses of anti-hypertensive drug treatment compared to placebo or no treatment trials up until the end of 2011. Selection criteria: RCTs of at least 1 year duration. Data collection and analysis: The outcomes assessed were mortality, stroke, coronary heart disease (CHD), total cardiovascular events (CVS), and withdrawals due to adverse effects. MAIN RESULTS: Of 11 RCTs identified 4 were included in this review, with 8,912 participants. Treatment for 4 to 5 years with antihypertensive drugs as compared to placebo did not reduce total mortality (RR 0.85, 95% CI 0.63, 1.15). In 7,080 participants treatment with antihypertensive drugs as compared to placebo did not reduce coronary heart disease (RR 1.12, 95% CI 0.80, 1.57), stroke (RR 0.51, 95% CI 0.24, 1.08), or total cardiovascular events (RR 0.97, 95% CI 0.72, 1.32). Withdrawals due to adverse effects were increased by drug therapy (RR 4.80, 95% CI 4.14, 5.57), ARR 9%. AUTHORS’ CONCLUSIONS: Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs. Treatment caused 9% of patients to discontinue treatment due to adverse effects. More RCTs are needed in this prevalent population to know whether the benefits of treatment exceed the harms. Associação Paulista de Medicina - APM 2013-01-18 /pmc/articles/PMC10522316/ /pubmed/23338742 http://dx.doi.org/10.1590/S1516-31802012000600012 Text en https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons license. |
spellingShingle | Cochrane Highlights Diao, Diana Wright, James M. Cundiff, David K. Gueyffier, Francois Pharmacotherapy for mild hypertension |
title | Pharmacotherapy for mild hypertension |
title_full | Pharmacotherapy for mild hypertension |
title_fullStr | Pharmacotherapy for mild hypertension |
title_full_unstemmed | Pharmacotherapy for mild hypertension |
title_short | Pharmacotherapy for mild hypertension |
title_sort | pharmacotherapy for mild hypertension |
topic | Cochrane Highlights |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522316/ https://www.ncbi.nlm.nih.gov/pubmed/23338742 http://dx.doi.org/10.1590/S1516-31802012000600012 |
work_keys_str_mv | AT diaodiana pharmacotherapyformildhypertension AT wrightjamesm pharmacotherapyformildhypertension AT cundiffdavidk pharmacotherapyformildhypertension AT gueyffierfrancois pharmacotherapyformildhypertension |