Benefits of treatment for prehypertensive patients confirmed
MedWire News: Antihypertensive therapy reduces the risk for stroke in people with prehypertension, results of a meta-analysis confirm.
"We do not think that giving blood pressure medicine instead of implementing the lifestyle changes is the way to go," cautioned lead researcher Ilke Sipahi (Case Western Reserve University School of Medicine, Cleveland, Ohio, USA), in a press statement.
"However, the clear-cut reduction in the risk of stroke with blood pressure pills is important and may be complementary to lifestyle changes."
Prehypertension, referred to as high-normal blood pressure in European guidelines, covers the systolic range 120-139 mmHg and the diastolic range 80-89 mmHg, although the researchers note that this definition, as well as the 140/90 mmHg threshold for hypertension, is "arbitrary."
The meta-analysis, which appears in the journal Stroke, includes 16 trials with 70,664 patients. Overall, those randomly assigned to antihypertensive treatment had a significant 22% reduction in the risk for stroke, relative to patients assigned to placebo.
The effect persisted even among trials in which patients' average blood pressure at baseline was lower than 130/85 mmHg, at a 35% reduction in stroke risk, and was consistent across all antihypertensive drug classes.
Sipahi et al note that it would be necessary to treat 169 patients for an average of 4.3 years to prevent one stroke. They say that this is "somewhat larger than the number needed to treat for a hypertensive patient," but add that the number needed to treat "is likely to vary substantially depending on the patient population studied."
There was an overall nonsignificant trend toward a reduction in risk for myocardial infarction and cardiovascular death among patients given antihypertensive treatment versus placebo.
However, there was significant heterogeneity among the trials, and the researchers believe that the trends "were likely driven by the ACE-inhibitor trials in patients with established atherosclerotic disease or very high cardiovascular risk."
They say: "Exclusion of the above trials caused the trend toward risk reduction to disappear."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Eleanor McDermid