Summary of findings for the main comparison. Antihypertensive drug therapy compared to control for hypertension in adults aged 18 to 59 years.
| Antihypertensive drug therapy compared to control for hypertension in adults aged 18 to 59 years | ||||||
| Patient or population: adults aged 18‐59 years with primary hypertension (mild to moderate systolic or diastolic hypertension) Setting: outpatient Intervention: antihypertensive drug therapy (mean duration: 5 years) Comparison: control (placebo or untreated) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with control | Risk with antihypertensive drug therapy | |||||
| All‐cause mortality | 24 per 1000 | 23 per 1000 (19 to 28) | RR 0.94 (0.77 to 1.13) | 16,776 (5 RCTs) | ⊕⊕⊝⊝ Low 1,2 | ‐ |
| Total cardiovascular mortality + morbidity | 41 per 1000 | 32 per 1000 (27 to 37) | RR 0.78 (0.67 to 0.91) | 17,278 (6 RCTs) | ⊕⊕⊝⊝ Low 1,3 | ARR 0.9%, NNTB = 112 |
| Cerebrovascular mortality + morbidity | 13 per 1000 | 6 per 1000 (5 to 9) | RR 0.46 (0.34 to 0.64) | 17,278 (6 RCTs) | ⊕⊕⊝⊝ Low 1,3 | ARR 0.7%, NNTB 143 |
| Coronary heart disease mortality + morbidity | 26 per 1000 | 26 per 1000 (21 to 31) | RR 0.99 (0.82 to 1.19) | 16,241 (4 RCTs) | ⊕⊕⊝⊝ Low 1,3 | ‐ |
| Withdrawal due to adverse events | 7 per 1000 | 32 per 1000 (11 to 93) | RR 4.82 (1.67 to 13.92) | 1,223 (3 RCTs) | ⊕⊝⊝⊝ Very low 1,2,4 | ARI 3.8%, NNTH 27 |
|
Decrease in SBP5 at end of 1 year |
The mean SBP was 0 | MD 14.98 lower (20.44 lower to 9.52 lower) | ‐ | 14,845 (3 studies) | ⊕⊝⊝⊝ Very low 1,3,7 | ‐ |
|
Decrease in DBP6 at end of 1 year |
The mean DBP was 0 | MD 7.62 lower (10.55 blower to 4.69 lower) | ‐ | 15,857 (4 studies) | ⊕⊝⊝⊝ Very low 1,3,7 | ‐ |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). ARI: absolute risk increase; ARR: absolute risk reduction; CI: confidence interval; DBP: diastolic blood pressure; MD: mean difference; NNTB: number needed to treat for an additional beneficial outcome; NNTH: number needed to treat to for an additional harmful outcome; RCT: randomized controlled trial; RR: risk ratio; SBP: systolic blood pressure. | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
1Several additional trials met the inclusion criteria but did not report data in the 18‐ to 59‐year‐old subgroup of participants (which are listed under Characteristics of excluded studies table).
2Imprecision due to wide confidence interval.
3High risk of bias due to lack of blinding of physician and participants as well as incomplete outcome data reporting in the MRC‐TMH trial.
4Only 3 out of 7 included trials reported this outcome. The data from MRC‐TMH 1985 for this subgroup were not available. High risk of attrition bias and unclear risk of reporting bias of the USPHSHCSG 1977 study which contributes 100% weight to the effect size.
5The range of change in SBP in the control group ranged from increase by 1.5 mmHg to decrease from 9 to 14 mmHg.
6The range of decrease in DBP in the control group ranged from 0.6 mmHg to 7 mmHg.
7Significant heterogeneity (I2 > 95%).