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Benefits and harms of antihypertensive treatment for low risk mild hypertension: a real world, matched cohort study of over 38,000 adults

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dc.contributor.authorShepard, James P
dc.contributor.authorStevens, Sarah
dc.contributor.authorStevens, Richard
dc.contributor.authorMartin, Una
dc.contributor.authorMant, JWF
dc.contributor.authorHobbs, Richard
dc.contributor.authorMcManus, Richard J
dc.contributor.orcidMant, Jonathan [0000-0002-9531-0268]
dc.date.accessioned2018-09-10T22:17:35Z
dc.date.available2018-09-10T22:17:35Z
dc.description.abstractImportance: Evidence to support initiation of pharmacological treatment in patients with low-risk mild hypertension is inconclusive, with previous trials underpowered to demonstrate benefit. Clinical guidelines across the world are contradictory. Objective: Use electronic health records to examine whether treatment is safe and effective at reducing the risk of mortality and cardiovascular disease in low-risk mild hypertensives. Design: Longitudinal cohort study. Setting: Linked electronic health records from primary and secondary care in England. Participants: Data were extracted from patients in the Clinical Practice Research Datalink, between 1998-2015, aged 18-74 years, with mild hypertension (untreated blood pressure between 140/90-159/99mmHg) and no previous treatment. Anyone with a history of cardiovascular disease (CVD) or CVD risk factors was excluded. Patients exited the cohort if follow-up records became unavailable or they experienced an outcome of interest. Exposures: Prescription of antihypertensive medication. Propensity scores predicting likelihood of treatment were constructed using a logistic regression model. Individuals treated within 12 months of diagnosis were matched to untreated patients by propensity score using the nearest neighbour method. Main Outcome(s) and Measure(s): The rate of mortality, cardiovascular disease and adverse events in patients prescribed antihypertensive treatment at baseline, compared to those not, using Cox regression. Results: A total of 19,143 treated patients (mean age 54.7±11.8 years, 55.9% female) were matched to 19,143 similar untreated patients. During a median follow-up period of 5.8 years, no evidence of an association was found between antihypertensive treatment and mortality (HR 1.02, 95%CI 0.88-1.17), CVD (HR 1.09, 95%CI 0.95-1.25) or any individual cardiovascular disease endpoints. Treatment was associated with an increased risk of adverse events including hypotension (HR 1.69, 95%CI 1.30-2.20, NNH10=41), syncope (HR 1.28, 95%CI 1.10-1.50, NNH10=35), electrolyte abnormalities (HR 1.72, 95%CI 1.12-2.65, NNH10=111) and acute kidney injury (HR 1.37, 95%CI 1.00-1.88, NNH10=91).
dc.identifier.doi10.17863/CAM.27445
dc.identifier.issn2168-6114
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/280081
dc.language.isoeng
dc.publisherAmerican Medical Association
dc.titleBenefits and harms of antihypertensive treatment for low risk mild hypertension: a real world, matched cohort study of over 38,000 adults
dc.typeArticle
dcterms.dateAccepted2018-07-23
prism.publicationNameJAMA Internal Medicine
rioxxterms.licenseref.startdate2018-07-23
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionAM

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