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'No evidence' for treating low-risk patients with hypertension, study finds

There is 'no evidence' that lowering hypertension thresholds to treat low-risk patients has any benefit, a new study has found.

Researchers analysed nearly 40,000 low-risk patients across England, and found that not only was there no benefit to treating such patients with antihypertensive medication, it also had the potential to cause ‘harm’.

They found ‘no evidence to support guideline recommendations that encourage initiation of treatment in patients with low-risk mild hypertension’.

The study set out to examine whether antihypertensive treatment is associated with a reduced risk of mortality and cardiovascular disease in low-risk patients with mild hypertension.

The researchers, from the University of Oxford, University of Cambridge and University of Birmingham, analysed 38,286 English patient records looking at the time period of 1998 to 2015, and comparing the outcomes of those treated with antihypertensives with those who were not.

The paper said: ‘No evidence of an association was found between baseline exposure to antihypertensive treatment and mortality or CVD.

‘There was evidence to suggest that baseline treatment exposure may be associated with an increased risk of adverse events.’

It explained that while the risk of harm was small, ‘in the context of little evidence of benefit’, prescribers should be ‘cautious when initiating new treatment in this population, particularly because such an approach may affect millions of individuals’.

Study lead and Oxford University primary care health sciences researcher Dr James Sheppard said: ‘We found that, contrary to the latest US guideline recommendations, there was no evidence of any benefit to treating patients with low-risk mild hypertension.’

He added: ‘To ensure future guideline recommendations for treating low-risk mild hypertension are based on the best-quality evidence, large-scale clinical trials are now needed.’

Co-author Professor Jonathan Mant, from the University of Cambridge, said: ‘Given that we found tangible evidence of the potential harm of treating people with mild hypertension, and no evidence of benefit, this study does raise questions over the value of initiating drug treatment in such patients.’

It follows research earlier in the year that found lower treatment thresholds in older patients increased the risk of death and cognitive decline.