There is no convincing data to show the benefit from antihypertensive therapy in patients with mild hypertension and no preexisting cardiovascular disease. A meta-analysis combined four placebo-controlled trials totaling 8912 patients with mild hypertension and no preexisting cardiovascular disease. During 4 to 5 years of follow-up, antihypertensive therapy resulted in lower rates of mortality and stroke but higher rates of myocardial infarction. Low-risk patients with mild hypertension and no preexisting cardiovascular disease who fail to reduce their blood pressure with lifestyle modification should receive antihypertensive therapy.

Treatment of hypertension in frail older adults

Older adults who are frail may not benefit from antihypertensive therapy. In an observational study of 2340 adults older than 65 years, the association between blood pressure and mortality was examined according to whether or not individuals were frail. Frail is defined as an inability to walk 6 meters in less than 8 seconds. Among frail adults, there was no association between blood pressure and mortality. In addition, a higher blood pressure was associated with a lower risk of death among the most frail (i.e., those who could not walk the distance at all).