Revisión de la Cochrane / Hta moderada y tratamiento (publicado 15 de agosto 2012)

Cochrane review finds no proved benefit in drug treatment for patients with mild hypertension

BMJ 2012; 345 doi: 10.1136/bmj.e5511 

(Published 15 August 2012)

el editor

Background

People with no previous cardiovascular events or cardiovascular disease represent a primary prevention population. The benefits and harms of treating mild hypertension in primary prevention patients are not known at present. This review examines the existing randomised controlled trial (RCT) evidence.

Objectives

Primary objective: To quantify the effects of antihypertensive drug therapy on mortality and morbidity in adults with mild hypertension (systolic blood pressure (BP) 140-159 mmHg and/or diastolic BP 90-99 mmHg) and without cardiovascular disease.

Search methods

We searched CENTRAL (2011, Issue 1), MEDLINE (1948 to May 2011), EMBASE (1980 to May 2011) and reference lists of articles. The Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness (DARE) were searched for previous reviews and meta-analyses of anti-hypertensive drug treatment compared to placebo or no treatment trials up until the end of 2011.

Selection criteria

RCTs of at least 1 year duration.

Data collection and analysis

The outcomes assessed were mortality, stroke, coronary heart disease (CHD), total cardiovascular events (CVS), and withdrawals due to adverse effects.

Main results

Of 11 RCTs identified 4 were included in this review, with 8,912 participants. Treatment for 4 to 5 years with antihypertensive drugs as compared to placebo did not reduce total mortality (RR 0.85, 95% CI 0.63, 1.15). In 7,080 participants treatment with antihypertensive drugs as compared to placebo did not reduce coronary heart disease (RR 1.12, 95% CI 0.80, 1.57), stroke (RR 0.51, 95% CI 0.24, 1.08), or total cardiovascular events (RR 0.97, 95% CI 0.72, 1.32). Withdrawals due to adverse effects were increased by drug therapy (RR 4.80, 95%CI 4.14, 5.57), ARR 9%.

Authors' conclusions

Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs. Treatment caused 9% of patients to discontinue treatment due to adverse effects. More RCTs are needed in this prevalent population to know whether the benefits of treatment exceed the harms.

Los fármacos antihipertensivos utilizados en el tratamiento de  adultos (prevención primaria) con hipertensión leve (presión arterial sistólica 140-159 mmHg y / o diastólica mmHg BP 90-99) no han demostrado reducir la mortalidad o la morbilidad en ensayos controlados aleatoriamente. Un  9% de los pacientes discontinuó el der el tratamiento debido a efectos adversos. Serán necesarios mas ECA en esta población prevalentepara conocer si los beneficios del tratamiento superan los daños.