As much as it sounds unbelievable, it seems that pharmacological treatment of ‘mild’ hypertension in patients with low or moderate cardiovascular risk may not influence cardiovascular morbidity or mortality. A 2009 Cochrane review of the literature on treatment-of-hypertension targets  pointed out that no trials comparing different systolic blood pressure targets were found, and only seven trials (22,089 subjects) comparing different diastolic blood pressure targets were identified. Analysis of the data concluded that an attempt to achieve lower blood pressure targets instead of standard targets (< 140/90 mmHg) did not change the outcomes. In fact, this strategy did not prolong survival or reduce the risk for stroke, heart attack, heart failure or kidney failure. The authors pointed out that the net health effect of lower targets could not be fully assessed due to lack of information regarding all total serious adverse events and withdrawals due to adverse effects.
In the October edition of the [i]Journal of Hypertension[/i], the European Society of Hypertension has published a very long and detailed document  updating a previous statement issued in 2007. The relevant recommendations for non-elderly patients with grade 1 hypertension (blood pressure < 159/99 mmHg) who are at low or moderate cardiovascular risk are as follows. Non-pharmacological measures, such as lifestyle modifications should be initiated first and, only if unsuccessful, treatment with medications may be considered. However, once again this document stresses the fact that the evidence in favor of drug therapy in this clinical set-up is scanty. Also, it is stated that a too-drastic lowering of blood pressure (< 120/70 mmHg) may carry a risk (the J-curve phenomenon). As for the medications themselves, all groups are suitable, including beta-blockers, which were previously removed from the list.
Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel
Arquedas JA, Perez MI, Wright JM. Treatment blood pressure targets for hypertension. Cochrane Database Syst Rev 2009 Jul 8;(3):CD004349.
Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypert 2009. Epub ahead of print, Oct 15
Walsh JM, Pignone M. Drug treatment of hyperlipidemia in women. JAMA 2004;291:2243-52.
Algra A, Greving JP. Aspirin in primary prevention: sex and baseline risk matter. Lancet 2009;373:1821-2.