The Effect of Treatment on Mortality in Mild Hypertension

Abstract

In the Hypertension Detection and Follow-up Program, 7825 (71.5 per cent) of the 10,940 participants had diastolic blood pressures averaging between 90 and 104 mm Hg on entry into the study and were designated Stratum 1. Half were referred to their usual source of care in the community (the referred-care group), and half were treated intensively in special clinics (the stepped-care group). Five-year mortality in the Stratum 1 patients given stepped care was 20.3 per cent lower than in those given referred care (P less than 0.01). Particularly noteworthy was the beneficial effect of stepped-care treatment on persons with diastolic pressures of 90 to 104 mm Hg who had no evidence of end-organ damage and were not receiving antihypertensive medication when they entered the study. This subgroup had 28.6 per cent fewer deaths at five years among those treated with stepped care than among those treated with referred care (P less than 0.01). These findings support a recommendation that in patients with mild hypertension, treatment should be considered early, before damage to end organs occurs.

Ameliorative Effect of Hydroethanolic Leaf Extract of Byrsocarpus coccineus in Alcohol- and Sucrose-Induced Hypertension in Rats

“…[38] With epidemiological studies revealing that hypertension is a “silent killer” with no warning signs[293031] and many developing countries transiting from infectious to degenerative chronic diseases,[32] the prevalence of hypertension is on the increase. As a clinical and major public health problem[2] which affects about one-quarter of the world's adult population, hypertension as a modifiable, preventable, and controllable risk factor has reached epidemic proportions.…”

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

“…One of these, Chodosh et al, 99 found a statistically significant improvement in BP with complex interventions, although it noted heterogeneity in its results. Several of the systematic reviews' findings were also dominated by the results of the 'Hypertension Detection and Follow-up Program' 177 which, though useful, is unlikely to be relevant in the UK. There was some evidence that nurse-or pharmacist-led care was associated with improved BP control but, overall, the results for this were very mixed.…”

“…Evidence supporting organisational interventions was mixed, with findings dominated by the results of the 'Hypertension Detection and Follow-up Program'. 177 Other systematic reviews also found some evidence for complex interventions on BP. Schroeder et al 174 found weak and limited evidence for the benefit on BP of a patient-centred pharmaceutical model.…”

“…Ebrahim 170 found evidence that patient education showed a large reduction in BP but this result was dominated by the results of one study (the Hypertension Detection and Follow-up Program 177 ) which was a multifaceted US intervention that involved several approaches, including free care. Ebrahim 170 therefore concluded that the statistically insignificant improvements in BP seen in the other RCTs reviewed were more likely to be representative of the benefit of educational interventions [-0.7 mmHg (95% CI -2.8 to 1.4 mmHg) SBP and -0.6 mmHg (95% CI -1.6 to 0.4 mmHg) DBP].…”

Clinical Implications of the 2013 ESH/ESC Hypertension Guidelines: Targets, Choice of Therapy, and Blood Pressure Monitoring

“…Certainly, in low-to-moderate risk patients with uncomplicated hypertension, trial evidence supports that a reduction in SBP to <140 vs. >140 mmHg is associated with reduced adverse CV outcomes [13–15]. Other supportive evidence for intensive BP lowering in a range of patients is available, showing a lower risk of major CV events, especially stroke [16, 17] (Table 1).…”