Drug treatment of mild hypertension to reduce the risk of CHD: is it worth-while?

Although hypertension is regarded as a causal factor for coronary heart disease (CHD) a reduction in the risk of CHD as a result of lowering blood pressure in mild hypertension could not be demonstrated. This conclusion is based on an overview analysis of all published randomized trials in mild hypertension, including more than 25,000 subjects contributing over 125,000 person years of observation. There is evidence that treatment reduces the risk of CHD in moderate to severe hypertension. In addition the pooling of four clinical trials with treated control groups indicates a reduction in the risk of CHD of borderline significance with beta-blockers or aggressive treatment when compared with standard treatment (mostly diuretics). The failure of drug treatment to reduce the risk of CHD in mild hypertension is consistent with the results from epidemiological studies because of derangement of the lipid profile induced by diuretics and beta-blockers.