Hypertension Heresy: Are We Overtreating High Blood Pressure? - The People's Pharmacy
Until August 15, 2012, if you asked almost any American physician whether someone with a blood pressure reading of 145/95 should be treated with medication, the answer would have been a resounding yes! Medical students and residents are taught that hypertension increases the risk of heart attacks, strokes and early death. Physicians have come to believe that aggressive treatment of patients with high blood pressure will lead to better outcomes.
Everything changed on August 15, 2012, when the Cochrane Collaboration published its analysis: "Benefits of antihypertensive drugs for mild hypertension are unclear." The Cochrane Collaboration represents the highest level of scientific scrutiny of available studies. The experts who analyze the data are independent and objective and have come to be regarded as the ultimate authority on the medical interventions they evaluate. As far as we can tell, there is no better organization for assessing the pros and cons of pharmaceutical and alternative therapies than Cochrane.
There is no doubt that this review will create extraordinary controversy and push-back from the medical community. A bedrock belief is being challenged. That's because these experts are suggesting that most of the nearly 70 million Americans diagnosed with high blood pressure are probably being treated unnecessarily. The researchers reviewed data from nearly 9,000 patients enrolled in four randomized controlled trials. These were people who had been diagnosed with what is called stage 1 hypertension. That means their systolic blood pressure was between 140-159 and their diastolic blood pressure was between 90 and 99.
Here is what the Cochrane Collaboration found:
"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."