Blog | Thursday, September 20, 2012

Are we treating too many patients for hypertension?


What defines hypertension as a diagnosis? The absolute number must be arbitrary, and should be chosen to predict that treatment improves outcomes. If we believe in using the evidence, then we must examine the evidence in favor of treating "mild hypertension." A new meta-analysis suggests that we need not treat mild hypertension. This should make us wonder at the definition of hypertension.

Antihypertensive treatment in patients with a systolic blood pressure of 140 mm Hg to 159 mm Hg or a diastolic pressure of 90 mm HG to 99 mm Hg did not significantly reduce all-cause mortality, stroke, coronary heart disease, or total cardiovascular events, Diana Diao, of the University of British Columbia in Vancouver, and colleagues reported in a Cochrane review.

That lack of benefit was accompanied by a significant increase in withdrawals due to adverse effects (RR, 4.80; 95% CI, 4.14 to 5.57), which occurred at a rate of 8.9% in the single trial that provided that information.

For those readers who have been reading recent rants, you can anticipate the outcry from the hypertension community. The affect heuristic changes how we view any situation. Hypertension experts like the IDEA that lowering blood pressure to "normal" should help all patients. Thus, they will overestimate the value, and undervalue any dissenting data.

In general, the medical community labels too many people with "disease." We use too many drugs, and all drugs have side effects.

I hope we see more exploration of this issue. Bravo to the authors for having the courage to fight the establishment.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.