Blood pressure-lowering pharmacologic therapy may have significant effects on reduction of cardiovascular events in patients with grade 1 hypertension (140–159/90–99mmHg), particularly for those with an elevated absolute cardiovascular risk. A systematic literature review in the Annals of Internal Medicine examined data comprised of randomized controlled trials (RCTs) with a duration of at least one year that included 15,266 patients ≥18 years, at least 80% of whom had grade 1 hypertension and no previous cardiovascular disease. Of the patients for whom data on cardiovascular outcomes was available, 5.1% developed cardiovascular disease (cumulative event rates of 2.8% for coronary events and 1.8% for stroke).
Blood pressure-lowering therapy was associated with statistically significant reductions in stroke, cardiovascular deaths, and total deaths; over five years, odds ratios were 0.86 (95% CI, 0.74–1.01) for total cardiovascular events, 0.72 (CI, 0.55–0.94) for strokes, 0.91 (CI, 0.74–1.12) for coronary events, 0.80 (CI, 0.57–1.12) for heart failure, 0.75 (CI, 0.57– 0.98) for cardiovascular deaths, and 0.78 (CI, 0.67– 0.92) for total deaths. The average blood pressure reduction was approximately 3.6/2.4mmHg.
The authors conclude that for clinicians, decision making based on absolute risk assessment may be the best approach in pharmacologic treatment to lower blood pressure in patients with grade 1 hypertension.
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