Treatment of hypertension aims to reduce mortality and cardiovascular complications. An antihypertensive treatment is justifiable when a patient’s blood pressure is higher than or equal to 160/95 mm Hg, even in the absence of any specific cardiovascular risk, since some drugs reduce the incidence of cardiovascular complications.

The World Health Organization (WHO) defines "mild arterial hypertension" as systolic blood pressure of 140 to 159 mm Hg and diastolic blood pressure of 90 to 99 mm Hg, because there is a slightly higher cardiovascular risk than with lower pressure.

A systematic review included four clinical trials evaluating an antihypertensive drug treatment in patients suffering from “mild arterial hypertension”. This study involved just under 9000 patients, mostly under the age of 50.

After 4 to 5 years' monitoring, the overall mortality rate among those taking an antihypertensive drug was similar to that of those not receiving treatment. There was no statistically significant difference between the two groups with regard to the frequency of coronary disease or stroke.

2013 saw no evidence that the harm-benefit balance of an antihypertensive drug treatment is favourable in patients whose systolic blood pressure is over 140/90 mm Hg but below 160/95 mm Hg, when there are no other cardiovascular event risk factors.

It is better to recommend non-drug measures for reducing cardiovascular risk, especially regular exercise and reducing salt consumption, and possibly to assist with weight loss and cutting down on excessive alcohol consumption.

©Prescrire 1 April 2014

"Treating blood pressure between 140/90 and 160/95 mmHg: no proven benefit" Prescrire Int 2014; 23 (148): 106. (Pdf, subscribers only).