Drug Therapy Has Little Value In Early Stage Hypertension

Amid the recent clamor over metanalyses suggesting that organic veggies are no more nutritious than conventional, and that omega-3’s may not reduce heart disease mortality, another important metanalysis got totally overlooked: the one showing that anti-hypertensive drugs are largely ineffective in people with Stage 1 hypertension.

University of British Columbia researchers digested data from 4 randomized placebo-controlled trials representing more than 8,900 people with mild hypertension, defined as systolic blood pressure 140-159 mm Hg or diastolic blood pressure 90-99 mm Hg. The “first line” drugs in question included thiazide or thiazide-like diuretics, beta blockers, and reserpine. Some patients in some studies were taking 2 or more drugs. Studies were between 4-5 years’ duration.

There were no meaningful differences in mortality, incidence of coronary heart disease, or total cardiovascular events between patients on active treatments and those on placebos. None of the drug classes showed any significant efficacy in reducing disease incidence or death. The investigators did find a trend toward reduced risk of stroke (0.3% with anti-hypertensives vs. 0.7% with control, p = 0.078) in the largest of the 4 trials, but other than that there were no other measurable benefits (Diao D, et al. Cochrane Database Syst Rev. 2012 Aug 15;8:CD006742 ).

There was, however, a significant side-effect burden associated with drug treatment. There was an aggregate 9% adverse response rate among the drug-treated patients, and five times more people on active treatment versus placebo dropped out of studies due to adverse events.

The UBC team acknowledged that their analysis is somewhat limited by the relatively short duration of the trials. Nonetheless, the report is important because the Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) guidelines advocate early drug treatment, and millions with Stage 1 hypertension are taking anti-hypertensives as primary prevention. According to this new review, that may be a massive waste of money.

Thanks to our friends at DynaMed for calling our attention to this report.

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