Taking Antihypertensives even When You Don’t Have Hypertension

People are bad about taking medications if they can’t see a beneficial effect – especially if they do experience side effects.  This means that blood pressure drugs (antihypertensives) often linger at the back of the medicine cupboard.  Physicians like to ensure that people with defined hypertension (systolic pressure over 140 mmHg or diastolic over 90 mmHg) take their prescribed meds, but they also treat many people with lesser levels of systolic pressure – sometimes as low as 115 mmHg.  An analysis has now been published in the Journal of the American Medical Association showing that people treated with antihypertensive drugs without defined hypertension may receive considerable health benefits.

This was a meta-analysis of published clinical trials of the effects of antihypertensive medications in people with cardiovascular disease but without clinically-defined hypertension.  There were 25 trials that met the strict predetermined inclusion criteria; they included 64,000 subjects without high blood pressure, of whom 76% were men. 

Compared with controls, who took no antihypertensive meds, the treated subjects had a 23% reduction in the risk for stroke, a 29% reduction in the risk for congestive heart failure, a 15% reduction in the risk for any other cardiovascular events, and a 13% reduction in the risk for all-cause mortality.  These results didn’t differ with different trial designs or in various clinical subgroups.

The population experiencing these benefits included the group with blood pressure in the ‘prehypertensive’ range - a systolic pressure from 120 to 140 mmHg or a diastolic pressure from 80 to 89 mmHg.  It’s been calculated that nearly 30% of the adult US population has prehypertension.  In this analysis the study subjects had to have a cardiovascular condition to qualify for treatment with an antihypertensive, but the findings clearly show that these drugs have obvious benefits beyond just lowering blood pressure.  The lesson for all of us is: “Take Your Meds”!