It is very puzzling for most of us why stage1 hypertension has not shown reduction of CV events. Stage 1 hypertension is 140-159/ 90-99 mmHg.
The results from Lewington et al meta-analysis, have shown that the cardiovascular mortality doubles from coronary heart disease and stroke above a BP level of 115/75 mmHg with each 20 mmHg rise in systolic BP and 10 mmHg rise in diastolic BP. But studies of stage 1 hypertension have shown no benefit by reduction BP with antihypertensive drugs. This is apparently a contradiction. In Cochrane Database of Systematic Reviews met analysis treating stage 1 hypertension with antihypertensive treatment did not reduce cardiovascular events and stroke.
In my opinion: – Hypertension is a disease of more pressure, inflammation and metabolic syndrome. Our antihypertensive drugs are effective in reducing blood pressure but not inflammation or handling metabolic syndrome. At high pressure, damage by pressure is significant and our antihypertensive so benefit, in terms of CV events. But in case of stage 1 hypertension, pressure damage may be not that significant but inflammation and metabolic syndrome are still working. Our drugs only handle blood pressure so significant benefit of reducing blood pressure may not be evident at stage 1 hypertension.
So life style modification and handling metabolic syndrome, is very important in managing hypertension, apart from reducing blood pressure with antihypertensive drugs.