Is hypertension overtreated?
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Is hypertension overtreated?
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In a recent column, Des Spence has written insightfully about the potential problem of the overtreatment of hypertension. He points to a Cochrane review of hypertension that found that treating blood
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Is hypertension overtreated?
posted at 5/9/2012 11:14 AM BST
on bmj.com
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Posts: 1450
First: 7/4/2011 Last: 24/5/2013 |
In a recent column, Des Spence has written insightfully about the potential problem of the overtreatment of hypertension. He points to a Cochrane review of hypertension that found that treating blood pressure of 160/100 is ineffective.1 He also says that NICE recommend treatment for hypertension only after a risk assessment using the QRisk algorithm to predict cardiovascular disease but that he suspects that many doctors ignore and “treat according to blood pressure readings, possibly leading to overtreatment for millions more patients.” One reason given is that risk is difficult to communicate and therefore it is simpler just to treat: “Risk calculations might make some sense at a population level but are meaningless to most individuals” Also, if you tell a patient they have high blood pressure but don’t do anything about it, what message does this send to the patient? The article starts and ends with the claim that doctors do not get sued for overtreatment (opposed to maltreatment or undertreatment). Is hypertension being overtreated? Why might doctors ignore NICE’s guidance? Is there a tendency to treat according solely on BP readings? Does the fear of ‘what if’ haunt clinical practice and cause overtreatment of hypertension?
http://www.bmj.com/content/345/bmj.e5923 |
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Re: Is hypertension overtreated?
posted at 5/9/2012 11:35 AM BST
on bmj.com
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Posts: 1271
First: 13/4/2010 Last: 23/5/2013 |
hey Matthew - Joey posted already on this subject (and the Cochrane review) on 16th August when my response was as follows: What we are talking about here is stage 1 hypertension. The UK NICE/British Hypertension Society guidelines of 2011 clearly state that drug therapy should only be considered in these patients if they are under 80 with one or more of the following: - target organ damage - established cardio-vascular disease - renal disease - diabetes - a 10 year CVD risk />20% So the Cochrane review doesn't alter how I would treat these people. If they have no risks I wouldn't treat. Of course that does not mean they shouldn't be pursuing standard lifestyle measures |
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Re: Is hypertension overtreated?
posted at 5/9/2012 2:19 PM BST
on bmj.com
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Posts: 3045
First: 27/3/2012 Last: 20/5/2013 |
The mild hypertensive patients should not be treated unless one of the indications as sited by skyesteve is present. Generally the patients are treated for hypertension in the very first visit without following them sufficiently. |
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Re: Is hypertension overtreated?
posted at 6/9/2012 11:49 AM BST
on bmj.com
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Posts: 878
First: 17/6/2011 Last: 24/5/2013 |
I agree with skyesteve and I also think that we are using drugs to treat a lifestyle disease. As far as I can work out mild hypertension can usually be 'cured' by diet, exercise and weight loss! sadian |
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Re: Is hypertension overtreated?
posted at 6/9/2012 12:16 PM BST
on bmj.com
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Posts: 3045
First: 27/3/2012 Last: 20/5/2013 |
I strongly agree with both, Skyesteve & Sadian. In the primary conditions the hypertension be managed by dietary & exercise modifications as well as lifestyle changes, & relaxing techniques like 'Yoga' |
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Re: Is hypertension overtreated?
posted at 6/9/2012 9:54 PM BST
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Hi Matthew: Thanks for this smart post. And I agree with Des Spence, I am sure that Hypertension is overtreated. The NICE guidelines are not followed by the book by many physicians, and still is not influential overseas. ABPMs are much less done than needed!!! Office and Home BPs both give a lot of false positive results. I see with ABPM a lot of White Coat "hypertension" with no cardiovascular disease. These people are just taking unnecessary drugs, instead of Lifestyle interventions. All Best, Joey |
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Re: Is hypertension overtreated?
posted at 24/9/2012 1:51 PM BST
on bmj.com
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Posts: 92
First: 20/3/2012 Last: 25/10/2012 |
It's an easy answer: Yes. But, in reality, it is not an easy answer. In this day and age, there are so many factors that need considering. 1) Disregard of NICE/ protocol: It could be due to time pressures and quicker to prescribe than do a Cardiovascular risk screen; patient pressure: Patients have much more knowledge and are much more questioning than before and, if they see a Blood Pressure reading above "normal" (a significant number of the population could quote you the 120/80), are going to be forceful in wanting it treated; maybe some doctors have realised that some patients just will not stay the course with exercise, diet etc and it's easier to prescribe; Unaware of the change in NICE Guidelines? 2) How many medications are commenced on the basis of a one-off blood pressure reading rather than investigating and instigating 24-hour blood pressure monitoring? Those are the main factors I can think of at this time. My concern, future-wise, will be with the introduction of Poly-Pills, especially if proper Cardiovascular screening is not carried out. Hopefully, this is something that can be addressed.
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Re: Is hypertension overtreated?
posted at 30/9/2012 8:05 AM BST
on bmj.com
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Posts: 1790
First: 7/3/2009 Last: 24/5/2013 |
May a share some of my views: Target blood pressure is constantly pushed down to the point that anything above 120/80 is considered not good enough, LDL cholesterol levels are pushed down and down so that LDL above 70 is a terrible word for cardiologists, and you can find those that would like to push it below 50 in people with CVD. Remember what happened with HBA1C levels in diabetics? Ultimately those who pushed for the value of 6% had to face a study that has shown more complications compared to the cutoff of 7%. Instead of pushing values down with medications I believe we should encourage weight reduction, healthy dietary and lifestyle habits and moderate physical activity as beneficial modalities. |
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Re: Is hypertension overtreated?
posted at 1/10/2012 6:20 AM BST
on bmj.com
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Posts: 624
First: 13/4/2011 Last: 15/5/2013 |
Dear All: I could argue that High Blood Pressure Levels are among the best Surrogates for Cardiovascular Diseases, or even that Essential Hypertension is the most common cardiovascular disease. But I think this is not just an intellectual discussion.......because Hypertension is just another Surrogate for cardiovascular disease, really meaning a whole bunch of different disease states inside those numbers! So, Yoram is right! As physicians, we should not just treat numbers, Surrogates, or Laboratory values. We should be smart enough and treat the individual patient. This target of BP below 120/80 mmHg for all below 80 years old seems to be just a foolish statement! All the Best, Joey |
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