Current American College of Cardiology/American Heart Association guidelines recommend the initiation of pharmacologic antihypertensive treatment in patients with mild hypertension. Yet, there is a lack of clinical trial evidence supporting such an approach in patients who have a low cardiovascular disease (CVD) risk and mild hypertension. Researchers conducted a retrospective longitudinal cohort study using electronic health records data to evaluate the association between antihypertensive treatment and all-cause mortality, CVD, and adverse events in low-risk patients with mild hypertension (defined as three consecutive readings of 140/90 mmHg to 159/99 mmHg) and no history of CVD or CVD risk factors. A total of 19,143 patients who received antihypertensive treatment were matched to the same number of untreated patients. This sample population was followed for a median of 5.8 years. Mean blood pressure before initiation of treatment was 146/89 mmHg.

Overall mortality during follow-up was similar in the two groups: 4.08% in untreated patients and 4.49% in treated patients. Also, no significant association was found between antihypertensive treatment and CVD. There was, however, a significant association between antihypertensive treatment and time to adverse events, including hypotension, syncope, electrolyte abnormalities, and acute kidney injury.

The study authors conclude that physicians should be cautious when initiating pharmacologic antihypertensive treatment in low-risk patients with mild hypertension, and patients should be informed about the limited evidence of treatment efficacy. They note, however, that observational data may be biased by unmeasured confounding factors. Furthermore, the benefits of treatment may take longer to manifest in a low-risk population and may have become evident had data been available for the researchers to follow up for a longer period. They also point out that treatment was determined by prescriptions issued, but they did not ascertain whether these were filled or if patients took the medicine as prescribed.

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