Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Treating Low-Risk Patients with Mild Hypertension

JAMA Intern Med; ePub 2018 Oct 29; Sheppard, et al

Initiating antihypertensive treatment in low-risk patients with mild hypertension has little or no benefit and may increase risk of adverse events, according to a new study. The longitudinal cohort study included electronic health records of 38,286 low-risk patients with mild hypertension (mean age 54.7 years, 56% women). Patients treated with an antihypertensive medication were matched 1:1 to similar untreated patients. The primary outcomes were rates of mortality, cardiovascular disease (CVD), and adverse events among those prescribed antihypertensive treatment at baseline, compared with those untreated. Researchers found:

  • During a median follow-up of 5.8 years, no evidence of an association was found between antihypertensive treatment and mortality (hazard ratio [HR], 1.02) or between antihypertensive treatment and CVD (HR, 1.09).
  • Treatment was associated with an increased risk of adverse events, including hypotension, syncope, and acute kidney injury.


Sheppard JP, Stevens S, Stevens R, et al. Benefits and harms of antihypertensive treatment in low-risk patients with mild hypertension. [Published online ahead of print October 29, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.4684.