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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 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?