Frank J. Domino, MDDisclosures
March 03, 2015
Editor’s Note: This article is derived from a lecture presented by Dr Domino at the American Academy of Family Physicians October 2014 conference.
Best Strategies for Treatment of Hypertension
Although much remains unknown about the best therapies for treatment of hypertension, an increasing body of evidence sheds light on some of the important questions.
Should we be treating patients with mild hypertension? A Cochrane review analyzed four randomized controlled trials involving almost 9000 patients with mild hypertension (systolic blood pressure [SBP] 140-159 mm Hg and/or diastolic blood pressure [DBP] 90-99 mm Hg) and without cardiovascular disease (CVD) treated with antihypertensive therapy or placebo for an average of 4-5 years. The reviewers found no difference between treated and untreated individuals in the incidence of coronary heart disease, stroke, total cardiovascular (CV) events, and death. Furthermore, about 9% of patients treated with drugs discontinued treatment owing to adverse effects. The bottom line? Treating mild hypertension provides little prevention of CVD in the short term; use the least bothersome first-line agent as possible.