1. Pharmacologic blood pressure reduction in patients with grade 1 hypertension, but no evidence of cardiovascular disease, was associated with a decreased risk of stroke, cardiovascular death, and all-cause mortality.
Evidence Rating Level: 1 (Excellent)
Study Rundown: No clear evidence exists for the benefits of treating patients without cardiovascular disease but with grade 1 hypertension (i.e., systolic blood pressure between 140-159 mmHg and/or diastolic pressure between 90-99 mmHg). Recent reviews addressing blood pressure reduction in grade 1 hypertension did not detect a benefit, but more recent trials have increased the potential for analysis. The Blood Pressure Lowering Treatment Trialists’ Collaboration (BPLTTC) conducted a systematic review and meta-analysis of the treatment of patients with grade 1 hypertension and free of overt cardiovascular disease, which demonstrated beneficial cardiovascular effects, including reductions in stroke, cardiovascular death, and total mortality. Although interventions only led to small reductions in absolute blood pressure and event outcomes, these results support a mild, but statistically significant, benefit to pharmacologic blood pressure reduction in patients with grade 1 hypertension and no overt cardiovascular disease, especially those with an elevated baseline risk.
Relevant Reading: Pharmacotherapy for mild hypertension
In-Depth [systematic review and meta-analysis]: This study was built on a systematic review published 2012, the trials of which provided 8,905 patients to the BPLTTC database of 6,361, for a total of 15,266 patients with grade 1 hypertension but no cardiovascular disease (7,842 on active therapy and 7,424 controls). Sub-groups of participants were identified from BPLTTC data and included analyses for angiotension-converting enzyme inhibitors (ACE-Is) vs. placebo, calcium channel blockers (CCBs) vs. placebo, diuretics vs. placebo, and more-intensive vs. less-intensive regimens. The average achieved blood pressure difference between active and control groups in the BPLTTC studies was 3.6/2.4 (SBP/DBP) mmHg. BPLTTC groups showed mild absolute risk reductions (ARR) of 0.8% (95%CI 0.2-1.3%) for stroke, 0.8% (95%CI 0.1-1.3%) for cardiovascular death, and 1.4% (95%CI 0.5-2.2%) for total deaths. The results from BPLTTC groups and non-BPLTTC groups did not differ substantially. A contemporary primary care-based cohort revealed similar results with ARR of 1.2% (95%CI 0.3-1.9%) for strokes, 0.6% (95%CI 0.1-1.1%) for cardiovascular deaths, and 1.0% (95%CI 0.3-1.4%) for total deaths.
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