Ten trials (8,667 patients) were eligible. Trial quality appeared variable with less than 10% loss to follow-up in all trials but failure to describe the method of allocation concealment in six trials. Eight trials provided mortality data with pooled effect indicating no effect (RR 0.97, 95% CI 0.87 to 1.08), but there was moderate to substantial heterogeneity (Ι²= 48%). However, antihypertensive treatment did reduce the risk of heart failure (RR 0.49, 95% CI 0.37 to 0.67, seven RCTs, Ι²=33%) and non-fatal stroke (RR 0.78, 95% CI 0.63 to 0.97, nine RCTs, Ι²=44%). Every drug class had a statistically significant effect on reduction of systolic blood pressure but not diastolic blood pressure.