Public Health Impact of Antihypertensive Medication Use on Arterial Blood Pressure: A Pooled Cross-Sectional Analysis of Population Health Surveys

Diego Montano


The early initiation of antihypertensive drug therapy is conceived as one of the most important public health interventions addressing cardiovascular risk in the population. However, the actual contribution of this public health intervention to reduce blood pressure (BP) at the population level is largely unknown. Hence, the aim of the present investigation is to estimate the potential public health effects of the use of antihypertensive medication on BP in the population aged 16 and older. Data from three population health surveys periodically conducted in the United States, England, and Scotland are analysed (N = 362,275).


The effectiveness of antihypertensive medications in reducing the incidence of major cardiovascular events has been well documented in several meta-analytic studies of randomised-controlled clinical studies [1–3]. The most common antihypertensive medications comprise diuretics, angiotensin-converting enzyme inhibitors (ACE), angiotensin-receptor blockers (ARB), beta blockers, and calcium-channel blockers. Despite the fact that each medication class differs regarding its particular mode of action, previous research findings have suggested that the effects of different antihypertensives on blood pressure (BP) are rather similar [4, 5]. 

Materials and Methods

The investigation of the main question in the present study will be based on data from three population health surveys conducted periodically in the United States (U.S.), England, and Scotland. From a very general perspective, the surveys are random probability samples of the population in each country and consist of extensive questionnaires and standardised examination data on magnitudes such as BP, anthropometric measurements, blood and urine analytes, medical conditions, prescription medications, and socio-economic indicators. For all surveys, respondents age 16 and older with valid measurements were included in the analyses. The Health Survey for England (HSE) is a stratified random sample of private English households [18].


The results of the present study suggest that the changes in the average BP levels over time at the population level are more strongly related to secular trends, rather than changes in the proportion of individuals taking antihypertensive medications. On the one hand, the temporal patterns of decreasing or increasing BP measurements seem to affect all sub-populations, i.e., individuals taking no medications as well as those taking antihypertensive or other medications. Despite the fact that antihypertensive medications have been found to be effective in reducing BP (e.g., reduction of about 4.6/2.1 mmHg in systolic and diastolic BP for ACE inhibitors, respectively [1]).


Furthermore, the analyses suggest that the potential effects of antihypertensive medications on BP measurements are different for systolic and diastolic BP depending on whether respondents are under monotherapy or combined antihypertensive therapy. Whereas the effect sizes of monotherapy and combined therapy in reducing systolic BP per year tend to be of similar magnitude (−0.28 99% CI [−0.30; −0.25] and −0.27 99% CI [−0.30; −0.24], respectively), the annual reduction of diastolic BP among persons under combined therapy tends to be slightly larger than among those in monotherapy (e.g., −0.34 99% CI [−0.36; −0.32] and −0.31 99% CI [−0.32; −0.29], respectively).


The temporal patterns of decreasing or increasing BP measurements over time seem to affect all sub-populations, i.e., individuals taking no medications as well as those taking antihypertensive or other medications. From a public health perspective, these results point to large potential effects of non-pharmaceutical factors that may have a large impact on BP levels and that may be integrated more explicitly in the development of comprehensive and more efficient hypertension treatment options. Given the fact that the benefits of the intensification of antihypertensive drug therapy (e.g., lower BP targets and additional medications) have been found to be outweighed by the harms associated with that intervention, the present results emphasise the potential impact lifestyle modifications may have on lowering BP at the population level, especially the systolic component.

Citation: Montano D (2023) Public health impact of antihypertensive medication use on arterial blood pressure: A pooled cross-sectional analysis of population health surveys. PLoS ONE 18(8): e0290344.

Editor: Fares Alahdab, Houston Methodist Academic Institute, UNITED STATES

Received: April 14, 2023; Accepted: August 5, 2023; Published: August 21, 2023

Copyright: © 2023 Diego Montano. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data of HSE and SHS are publicly available on request from the UK Data Service established by the Economic and Social Research Council in the United Kingdom NHANES data are publicly available from the Centers for Disease Prevention and Control at

Funding: The author received no specific funding for this work.

Competing interests: The author declares that no competing interests exist.

Abbreviations: ACE, Angiotensin-converting enzyme inhibitors; ARB, Angiotensin-receptor blockers; ATC, Anatomical Therapeutic Chemical Classification; BP, blood pressure; ESC, European Society of Cardiology; ESH, European Society of Hypertension; NHANES, The National Health and Nutrition Examination Survey; HSE, Health Survey for England; SHS, Scottish Health Survey

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