Antihypertensive Tx Analyzed in Younger, Predominantly Healthy Adults

A total of 17,327 individuals with mild-to-moderate primary hypertension aged 18-59 were included in the analysis
A total of 17,327 individuals with mild-to-moderate primary hypertension aged 18-59 were included in the analysis

For predominantly healthy adults aged 18–59 years who have mild-to-moderate primary hypertension, antihypertensive drugs may have a small absolute effect on reducing cardiovascular mortality and morbidity.

The findings come from a new meta-analysis conducted by researchers from the University of British Columbia, Canada. The benefits of antihypertensive treatments have been established for those over the age of 60 in previous systematic reviews. This review sought to determine the effects of antihypertensives in younger patients.

Data was collected from the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Hypertension Specialized Register, MEDLINE, Embase, the World Health Organization International Clinical Trials Registry and ClinicalTrials.gov. Trials were included if they were at least 1 year in duration and compared an antihypertensive to a placebo or no treatment in those aged between 18 and 59 with mild-to-moderate primary hypertension. 

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A total of 7 studies met the criteria. These studies included 17,327 individuals with mild-to-moderate primary hypertension. The average age of these individuals was 50 years and had a mean baseline blood pressure of 160/95mmHg. The average follow-up time was 5 years duration. Bendrofluazide 10mg daily or propranolol 80mg–240mg daily with addition of methyldopa if required, were the treatments used in the study.

Based on 6 studies, results showed that drug therapy may reduce total cardiovascular mortality and morbidity from 4.1% to 3.2% over 5 years (RR 0.78, 95% CI: 0.67–0.91). This, the authors stated, was a result of a reduction in cerebrovascular mortality and morbidity (1.3% with control vs 0.6% with treatment; RR 0.46, 95% CI: 0.34–0.64). However, evidence for this was considered low-quality.

Based on 5 studies, antihypertensive therapy may have little or no effect on all-cause mortality compared to placebo or untreated-control (2.4% with control vs 2.3% with treatment; low quality evidence; RR 0.94, 95% CI: 0.77–1.13). No conclusion was able to be drawn from blood pressure effects, as they varied between studies and the authors were uncertain as to how much difference treatment made.

They concluded that for adults aged 18–59 years with mild-to-moderate hypertension, “antihypertensive drugs have a small absolute effect to reduce cardiovascular mortality and morbidity primarily due to reduction in cerebrovascular mortality and morbidity.” The researchers proposed that any similar future trials should be at least 10 years in duration and should compare different first-line drug classes and strategies.

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