Clinical Perspective on Antihypertensive Drug Treatment in Adults With Grade 1 Hypertension and Low-to-Moderate Cardiovascular Risk: An International Expert Consultation

Alberto Morales Salinas, Antonio Coca, Michael H Olsen, Ramiro A Sanchez, Weimar K Sebba-Barroso, Richard Kones, Vicente Bertomeu-Martinez, Javier Sobrino, Luis Alcocer, Daniel J Pineiro, Fernando Lanas, Carlos A Machado, Fernando Aguirre-Palacios, Jose Ortellado, Gonzalo Perez, Rodrigo Sabio, Orlando Landrove, Delfin Rodriguez-Leyva, Alfredo Duenas-Herrera, Ayelen Rodriguez Portelles, Jose Z Parra-Carrillo, Daniel L Piskorz, Alfonso Bryce-Moncloa, Gabriel Waisman, Yuichiro Yano, Hector Ventura, Marcelo Orias, Dorairaj Prabhakaran, J Sundström, Jiguang Wang, Louise M Burrell, Alta E Schutte, Patricio Lopez-Jaramillo, Eduardo Barbosa, Josep Redon, Michael A Weber, Carl J Lavie, Agustin Ramirez, Pedro Ordunez, Salim Yusuf, Alberto Zanchetti

Hypertension is a leading risk factor for disease burden globally. An unresolved question is whether grade 1 hypertension (140-159/90-99mmHg) with low (cardiovascular mortality <1% at 10 years) to moderate (cardiovascular mortality ≥1% and <5% at 10 years) absolute total cardiovascular risk (CVR) should be treated with antihypertensive agents. A virtual international consultation process was undertaken to summarize the opinions of select experts. After holistic analysis of all epidemiological, clinical, psychosocial, and public health elements, this consultation process reached the following consensus in hypertensive adults aged <80 years: (1) The question of whether drug treatment in grade 1 should be preceded by a period of some weeks or months during which only lifestyle measures are recommended cannot be evidence based, but the consensus opinion is to have a period of lifestyle alone reserved only to patients with grade 1 "isolated" hypertension (grade 1 uncomplicated hypertension with low absolute total CVR, and without other major CVR factors and risk modifiers). (2) The initiation of antihypertensive drug therapy in grade 1 hypertension with moderate absolute total CVR should not be delayed. (3) Men ≥55 years and women ≥60 years with uncomplicated grade 1 hypertension should automatically be classified within the moderate absolute total CVR category, even in the absence of other major CVR factors and risk modifiers. (4) Statins should be considered along with blood-pressure lowering therapy, irrespective of cholesterol levels, in patients with grade 1 hypertensive with moderate CVR.