Observational study and participant-level meta-analysis on antihypertensive drug treatment-related cardiovascular risk.

Although antihypertensive therapy reduces cardiovascular risk, individuals who are treated with antihypertensive medication generally have a worse prognosis for cardiovascular disease than untreated people. We recently evaluated the impact of conventional blood pressure level based on two Japanese individual participant databases and found that conventional blood pressure at baseline was not or was weakly associated with cardiovascular events among patients under antihypertensive drug medication. In the general population in Ohasama and the Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressures study, self-measured home blood pressure significantly predicted cardiovascular outcomes in patients under antihypertensive treatment. Hypertension is a chronic disease, and blood pressure must be evaluated with repeated measurements over a long period of time. Therefore, although not proven by a randomized controlled trial, it is likely that the long-term management of hypertension by antihypertensive drug treatment should be based on self-measured home blood pressure. We should also pay careful attention to the residual cardiovascular risk in treated patients.