High blood pressure is the most important risk factor for premature death in the world. Currently, 1 billion people have clinically abnormal blood pressure (hypertension), and most cases are grade 1 (mild) hypertension (defined as systolic blood pressure of 140 to 159 mm Hg and/or a diastolic blood pressure of 90 to 99 mm Hg). Most trials of blood pressure-lowering treatments have been conducted in persons with grade 2 or 3 hypertension with established cardiovascular disease, while the benefit of treatment in grade 1 hypertension has been left largely unstudied.
However, a new meta-analysis published in Annals of Internal Medicine found that blood pressure lowering therapy is likely to prevent stroke and death in patients with uncomplicated grade 1 hypertension. The study authors, led by Dr. Johan Sundström, MD, PhD, of Uppsala University in Sweden, looked at over 15,000 patients with had grade 1 hypertension and no cardiovascular disease. The patients were previously included in studies comparing the use of intensive hypertension medication with placebos for high blood pressure, or studies comparing intensive medications with less intensive medications.
Patients in intensive treatments had an average drop in systolic blood pressure of 3.6 mm Hg and an average drop in diastolic blood pressure of 2.4 mm Hg. Also, over a follow-up period of about 5 years, these patients had a 28 percent reduced risk of stroke and a 25 percent reduced risk of cardiovascular death. High blood pressure is the most important risk factor for premature death, Dr. Sundström concludes. Blood pressure lowering therapy is likely to prevent stroke and death in patients with uncomplicated grade 1 hypertension.
ACSH s Dr. Gil Ross added this: There was, in addition to the statistically significant reductions in stroke and overall mortality, salutary trends in heart attacks and heart failure among the treated groups. While this result is not unexpected, I must note that the decrement in BP (3.6/2.4 mm) was quite small. Perhaps more aggressive BP lowering would have shown even more impressive results worth considering, given the extent of HBP-related disease and death.
