In primary prevention , the association of BP-lowering treatment with major cardiovascular events was dependent on baseline systolic BP ( SBP ) .
Conclusions and Relevance Primary preventive BP lowering is associated with reduced risk for death and CVD if baseline SBP is 140 mm Hg or higher .
At lower BP levels , treatment is not associated with any benefit in primary prevention but might offer additional protection in patients with CHD
Importance High blood pressure ( BP ) is the most important risk factor for death and cardiovascular disease ( CVD ) worldwide .
The optimal cutoff for treatment of high BP is debated .
Objective To assess the association between BP lowering treatment and death and CVD at different BP levels .
Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group.
OBJECTIVE To compare six antihypertensive interventions for the treatment of mild hypertension . DESIGN R and omized , double-blind , placebo-controlled clinical trial . SETTING Four hypertension screening and treatment centers in the United States . PARTICIPANTS Hypertensive men and women , aged 45 to 69 years , with diastolic blood pressure less than 100 mm Hg . INTERVENTION Sustained nutritional-hygienic advice to all participants to reduce weight , dietary sodium intake , and alcohol intake , and increase physical activity . Participants were r and omly allocated to take ( 1 ) placebo ( n = 234 ) ; ( 2 ) chlorthalidone ( n = 136 ) ; ( 3 ) acebutolol ( n = 132 ) ; ( 4 ) doxazosin mesylate ( n = 134 ) ; ( 5 ) amlodipine maleate ( n = 131 ) ; or ( 6 ) enalapril maleate ( n = 135 ) . MAIN OUTCOME MEASURES Blood pressure , quality of life , side effects , blood lipid levels and analysis of other serum components , echocardiographic and electrocardiographic changes , and incidence of cardiovascular events over an average of 4.4 years of follow-up . RESULTS Blood pressure reductions were sizable in all six groups , and were significantly greater for participants assigned to drug treatment than placebo ( -15.9 vs -9.1 mm Hg for systolic blood pressure and -12.3 vs -8.6 mm Hg for diastolic blood pressure ; P < .0001 ) . After 4 years , 59 % of participants assigned to placebo and 72 % of participants given drug treatment continued on their initial medication as monotherapy . A smaller percentage of participants assigned to the drug-treatment groups died or experienced a major nonfatal cardiovascular event than those assigned to the placebo group ( 5.1 % vs 7.3 % ; P = .21 ) . After including other clinical events , the percentage of participants affected was 11.1 % for those in the drug-treatment groups and 16.2 % for those in the placebo group ( P = .03 ) . Incidence rates of most resting electrocardiographic abnormalities were lower and quality of life was improved more for those assigned to drug-treatment groups rather than the placebo group . Differences among the five drug treatments did not consistently favor one group in terms of regression of left ventricular mass , blood lipid levels , and other outcome measures . CONCLUSIONS As an initial regimen , drug treatment in combination with nutritional-hygienic intervention was more effective in preventing cardiovascular and other clinical events than was nutritional-hygienic treatment alone . Drug-treatment group differences were minimal . Pending results from large-scale clinical trials to evaluate drug treatments for their effect on cardiovascular clinical events , these findings support the recommendations of the new fifth Joint National Committee report regarding treatment choices for people with stage 1 ( " mild " ) hypertension
In primary prevention , the association of BP-lowering treatment with major cardiovascular events was dependent on baseline systolic BP ( SBP ) .
Conclusions and Relevance Primary preventive BP lowering is associated with reduced risk for death and CVD if baseline SBP is 140 mm Hg or higher .
At lower BP levels , treatment is not associated with any benefit in primary prevention but might offer additional protection in patients with CHD
Importance High blood pressure ( BP ) is the most important risk factor for death and cardiovascular disease ( CVD ) worldwide .
The optimal cutoff for treatment of high BP is debated .
Objective To assess the association between BP lowering treatment and death and CVD at different BP levels .