An analysis of previous studies indicates that among patients with a history of cardiovascular disease, but not hypertension, use of high blood pressure medication is associated with a reduced risk of stroke, congestive heart failure and death from all causes, according to an article in the March 2 issue of JAMA. 1
Cardiovascular disease (CVD) is the leading cause of death in the United States and globally, representing 30 percent of all deaths worldwide. “Cardiovascular disease risk increases beginning at systolic blood pressure levels of 115 mm Hg. Use of antihypertensive medications among patients with a history of CVD or diabetes and without hypertension has been debated,” according to background information in the article. In adults 55 years and older, lifetime risk of developing hypertension is greater than 90 percent.
Angela M. Thompson, M.S.P.H., of the Tulane University School of Public Health and Tropical Medicine, New Orleans, and colleagues conducted a meta-analysis to evaluate the association between antihypertensive treatment and secondary prevention of CVD events and all-cause death among persons without clinically defined hypertension (140 mm Hg systolic or greater or 90 mm Hg diastolic or greater and/or use of antihypertensive medications or history of hypertension). From 874 potentially relevant publications, the researchers identified 25 trials that fulfilled the predetermined inclusion and exclusion criteria for the meta-analysis. These 25 studies incorporated data from 64,162 participants without hypertension, of whom 76 percent were men.
For the various outcomes, the researchers found that there was a 23 percent reduction in risk of stroke; 29 percent reduction in risk of congestive heart failure (CHF) events; 15 percent reduction in risk of composite (a combination of disease outcomes) CVD events; and a 13 percent reduction in risk for all-cause mortality.
“Our results show that persons with a history of CVD but with blood pressures in the normal and prehypertensive ranges can obtain significant benefit from antihypertensive treatments,” the authors write.
“Prehypertension affects nearly 30 percent of the adult population and carries an elevated risk for CVD incidence and mortality. To our knowledge, this meta-analysis is the first to examine the association between antihypertensive medications and CVD morbidity and mortality as well as all-cause mortality in individuals without hypertension. Among patients with clinical history of CVD but without hypertension, antihypertensive treatment was associated with decreased risk of stroke, CHF, composite CVD events, and all-cause mortality. Additional randomized trial data are necessary to assess these outcomes in patients without CVD clinical recommendations.”
Hector O. Ventura, M.D., and Carl J. Lavie, M.D., of the John Ochsner Heart and Vascular Institute, New Orleans, and University of Queensland School of Medicine, Brisbane, Australia, write in an accompanying editorial that because many patients with prehypertension could potentially begin taking medications at young ages and for many years to prevent cardiovascular events, even modest costs and adverse effects need to be considered. 2
“Lifestyle modifications that have been shown to reduce blood pressure and decrease cardiovascular morbidity and mortality should be recommended for all patients with blood pressure levels less than 140/90 mm Hg. However, to reach firmer conclusions will require more data from randomized trials involving patients with levels less than 140/90 mm Hg to evaluate the effects of various pharmacological therapies on preventing CVD outcomes.”
1. JAMA. 2011;305913-922.
2. JAMA. 2011;305940-941.