Sheppard JP, et al. – Researchers of this longitudinal cohort study drew on data from the Clinical Practice Research Datalink from January 1, 1998, to September 30, 2015, to investigate whether antihypertensive treatment is linked to a low risk of mortality and cardiovascular disease (CVD) in patients with low-risk of mild hypertension. Ultimately, they did not find any evidence to support guideline recommendations that encourage initiation of treatment in patients with low-risk mild hypertension. There was evidence of an increased risk of adverse events (hypotension, syncope, and acute kidney injury), suggesting that practitioners should exercise caution in following guidelines that generalize results from trials conducted in high-risk people to those at lower risk.

Methods

• Study participants included patients (18-74 years of age) who had mild hypertension (untreated blood pressure levels of 140/90-159/99 mm Hg) and no previous treatment.
• Anyone with a history of risk factors for CVD or CVD was excluded.
• Patients left the cohort if follow-up records were unavailable or had an interesting outcome.
• Main exposure included prescription of antihypertensive medication.
• Using a logistic regression model, propensity scores for likelihood of treatment were constructed.
• Using the nearest-neighbor method, individuals treated within 12 months of diagnosis were matched to untreated patients by propensity score.
• Main outcomes and measures included the rates of mortality, CVD, and adverse events among patients prescribed antihypertensive treatment at baseline, compared with those who were not prescribed such treatment, using Cox proportional hazards regression.

Results

• In total 19,143 treated participants were matched to 19,143 similar untreated patients.
• There was no evidence of association between antihypertensive treatment and mortality (hazard ratio [HR], 1.02; 95% CI, 0.88-1.17) or between antihypertensive treatment and CVD (HR, 1.09; 95% CI, 0.95-1.25) during a median follow-up period of 5.8 years (interquartile range, 2.6-9.0 years).
• Findings revealed that treatment was related to an increased risk of adverse events, including hypotension, syncope, electrolyte abnormalities, and acute kidney injury.