Would You Stop Using Drugs for Your Mild Hypertensive Patient?
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Would You Stop Using Drugs for Your Mild Hypertensive Patient?
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A just published Cochrane review is boiling the world of Hypertension. "Pharmacotherapy for mild Hypertension (Review). The Cochrane Collaboration 2012. Systolic BP levels 140-159 and/or 90-99 mmHg di
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Would You Stop Using Drugs for Your Mild Hypertensive Patient?
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Would You Stop Using Drugs for Your Mild Hypertensive Patient?
posted at 16/8/2012 8:08 PM BST
on bmj.com
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Posts: 627
First: 13/4/2011 Last: 18/6/2013 |
A just published Cochrane review is boiling the world of Hypertension. "Pharmacotherapy for mild Hypertension (Review). The Cochrane Collaboration 2012. Systolic BP levels 140-159 and/or 90-99 mmHg diastolic BP and without cardiovascular disease. Authors Conclusions: The large proportion of people treated with anti-hypertensive drugs have no cardiovascular disease and mild Hypertension. This Review have important implications. Most physicians have been treating such patients with false confidence that it was based on Randomised Clinical Trials evidence. Based on the best available evidence at the present time, this review does not show any signficant benefit of anti-hypertensive drug therapy in reducing mortality, heart attacks, strokes or overall cardiovascular events. 9% of patients choosed to withdraw drug treatment because of side-effects. It is likely that with this evidence, many mildly hypertensives with no cardiovascular disease would choose non-drug treatment (diet, exercise, stress management, etc.). Rather than drug treatment. What is your opinion about these findings and the author´s conclusions? All Best Joey |
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Re: Would You Stop Using Drugs for Your Mild Hypertensive Patient?
posted at 16/8/2012 8:49 PM BST
on bmj.com
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Posts: 1336
First: 13/4/2010 Last: 16/6/2013 |
Hi Joey - 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 standar lifestyle measures. |
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Re: Would You Stop Using Drugs for Your Mild Hypertensive Patient?
posted at 16/8/2012 9:31 PM BST
on bmj.com
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Posts: 627
First: 13/4/2011 Last: 18/6/2013 |
Hello skyesteve: I agree that this strategy is proposed in NICE 2011 Guidelines for Hypertension. But it seems that the vast majority of physicians outside the UK are not following this Guideline. See below the Plain Language Summary of this Meta-Analysis of RCT. P L A I N L A N G U A G E S U M M A R Y: Benefits of antihypertensive drugs for mild hypertension are unclear. Individuals with mildly elevated blood pressures, but no previous cardiovascular events, make up the majority of those considered for and receiving antihypertensive therapy. The decision to treat this population has important consequences for both the patients (e.g. adverse drug effects, lifetime of drug therapy, cost of treatment, etc.) and any third party payer (e.g. high cost of drugs, physician services, laboratory tests, etc.). In this review, existing evidence comparing the health outcomes between treated and untreated individuals are summarized. Available data from the limited number of available trials and participants showed no difference between treated and untreated individuals in heart attack, stroke, and death. About 9%of patients treated with drugs discontinued treatment due to adverse effects.Therefore, the benefits and harms of antihypertensive drug therapy in this population need to be investigated by further research.All Best, Joey |
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Re: Would You Stop Using Drugs for Your Mild Hypertensive Patient?
posted at 16/8/2012 11:30 PM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
In early hypertensive patients without complications & a regular follow up, we can safely withdraw the antihypertensive agents considering the risk- benefit ratio. In fact no patient can be labeled as having hypertension in the very first visit, as the CVS works completely under the autonomous nervous system & temporary rise of blood pressure is the most common phenomenon. Hence in such large group of patients, we cannot expect signficant benefit of anti-hypertensive drug therapy in reducing mortality, heart attacks, strokes or overall cardiovascular events. Patients instead choose to withdraw drug treatment because of side-effects. It is likely that with this evidence, many mildly hypertensives with no cardiovascular disease would choose non-drug treatment (diet, exercise, stress management, etc.), rather than drug treatment. I completely agree with the authors conclusion. |
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Re: Would You Stop Using Drugs for Your Mild Hypertensive Patient?
posted at 21/8/2012 8:42 AM BST
on bmj.com
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Posts: 627
First: 13/4/2011 Last: 18/6/2013 |
Hi All: Hypertension treatment is not an easy task at all. According to WHO it is the number one cause of death! The USA has 312 million people. Brazil has 212 million people. I think that as a whole the American Continent follow the JNC7 recommendations that do not emphasise life style intervention enough and propose intiation of drug therapy sometimes with combinations of drugs even in stage 1 uncomplicated Hypertension. There is also a highly influenced medical culture to medicalise Hypertension that prescribe drugs early on the treament of stage 1 hypertension. We can see the comments of Des Spence in the News section of BMJ about this Cochrane Review. ABPM is not still incorporated in the American guidelines, so, probably many people labelled as "patients" just have white coat hypertension. That´s why I think this recent meta-analysis is raising a lot of discussion about the best strategies for the treament of stage 1 hypertension. We are all waiting for the JNC8 report that is expected to come still in 2012. Meanwhile NICE 2011 guidelines are OK for me, but I suppose that do not have a much public health influence at least overseas. All Best, Joey
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