Hypertension increases the risk of stroke, heart attacks and heart failure; therefore, the main goal of treatment with antihypertensive medicines is to reduce this risk.
However, we are often faced with the decision on how to define hypertension and who to treat, especially in the otherwise healthy middle aged person...not to mention patients sent from the dentist’s office, pre-op clinic or pharmacy, with an elevated BP reading. Are they about to have a stroke?
A review by the Cochrane collaboration, looking at treatment for hypertension in middle aged adults concluded that:
"Antihypertensive drugs used to treat predominantly healthy adults aged 18 to 59 years with mild to moderate primary hypertension have a small absolute effect to reduce cardiovascular mortality and morbidity primarily due to reduction in cerebrovascular mortality and morbidity. All-cause mortality and coronary heart disease were not reduced."
Along the same lines, the Therapeutics Initiative from UBC, looking at Best Evidence for Management of Hypertension, concluded that:
- Antihypertensive drug treatment modestly reduces mortality and morbidity in people ≥ 60 with moderate to severe hypertension (>160/100);
- Low-dose thiazide diuretics are the best drug class for starting therapy;
- In mild hypertension (140-159/90-99), antihypertensive drugs have not been proven to reduce mortality and morbidity.
And for those referred to our offices on an urgent basis, a retrospective cohort study in the Journal of American Medical Association (Intern Med) concluded that:
"Hypertensive urgency is common, but the rate of Major Adverse Cardiovascular Events (MACE) in asymptomatic patients is very low. Visits to the ED were associated with more hospitalizations, but not improved outcomes."
So the advice that our patients sometimes hear from others - “You better see your doctor right away or you are going to have a stroke” - is pretty misleading.