Requiring additional classes of antihypertensive medications to maintain blood pressure was associated with an increased risk of incident stroke (HR 1.33; 95% CI 1.16-1.52 per class for normotensive).
Cohort (n=26,875)
Does pharmacological treatment of hypertension to normotensive levels reduce incident stroke risk to that of naturally normotensive individuals in adults aged 45+?
Pharmacological treatment of hypertension to guideline targets does not reduce stroke risk to the level of naturally normotensive individuals, highlighting the critical importance of primary prevention of hypertension.
Effect estimate: HR 1.33 (95% CI 1.16 to 1.52)
BACKGROUND AND PURPOSE: Although pharmacological treatment of hypertension has important health benefits, it does not capture the benefit of maintenance of ideal health through the prevention or delay of hypertension. METHODS: A total of 26 875 black and white participants aged 45+ years were assessed and followed for incident stroke events. The association was assessed between incident stroke and: (1) systolic blood pressure (SBP)categorized as normal (<120 mm Hg), prehypertension (120-139 mm Hg), stage 1 hypertension (140-159 mm Hg), and stage 2 hypertension (160 mm Hg+), and (2) number of classes of antihypertensive medications, classified as none, 1, 2, or 3 or more. RESULTS: During 6.3 years of follow-up, 823 stroke events occurred. Nearly half (46%) of the population were successfully treated (SBP<140 mm Hg) hypertensives. Within blood pressure strata, the risk of stroke increased with each additional class of required antihypertensive medication, with hazard ratio HR, 1.33; 95% confidence interval, 1.16 to 1.52 for normotensive, HR, 1.15; 95% confidence interval, 1.05 to 1.26 for prehypertension, and HR, 1.22; 95% confidence interval, 1.06 to 1.39 for stage 1 hypertension. A successfully treated (SBP<120 mm Hg) hypertensive person on 3+ antihypertensive medication classes was at marginally higher stroke risk than a person with untreated stage 1 hypertension (HR, 2.48 versus HR=2.19; relative to those with SBP <120 on no antihypertensive medications). CONCLUSIONS: Maintaining the normotensive status solely through pharmacological treatment has a profound impact, as nearly half of this general population cohort were treated to guideline (SBP<140 mm Hg) but failed to return to risk levels similar to normotensive individuals. Even with successful treatment, there is a substantial potential gain by prevention or delay of hypertension.
Howard et al. (Fri,) conducted a cohort in Hypertension (n=26,875). Antihypertensive medications vs. No antihypertensive medications was evaluated on Incident stroke (HR 1.33, 95% CI 1.16 to 1.52). Requiring additional classes of antihypertensive medications to maintain blood pressure was associated with an increased risk of incident stroke (HR 1.33; 95% CI 1.16-1.52 per class for normotensive).