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[What can be achieved by treatment with antihypertensive agents? Report from a hearing]
I Aursnes1, J B Osnes, E S Platou
1Institutt for farmakoterapi, Universitetet i Oslo.
Insights
Reducing high blood pressure can lower stroke, heart, and kidney failure risks. However, a J-shaped curve suggests careful blood pressure targets are crucial to avoid over-treatment and mortality risks.
Area of Science:
- Cardiology
- Nephrology
- Neurology
Background:
- Elevated blood pressure is a primary target for reducing morbidity and mortality.
- Potential benefits include reducing heart failure and renal failure.
- Coronary morbidity is less influenced and carries over-treatment risks.
Framework:
- A J-shaped relationship likely exists between blood pressure reduction and mortality.
- Drug treatment is considered for diastolic pressures exceeding 90 mm Hg after non-drug observation.
- Higher diastolic pressure levels (5-10 mm Hg) may be acceptable without other risk factors.
Implementation:
- All patients with diastolic pressure above 100 mm Hg require treatment.
- In patients with coronary disease, diastolic blood pressure should not fall below 85 mm Hg.
- Individuals with high doctor's readings and normal home readings should prioritize non-drug interventions.
Implications:
- Careful blood pressure management is essential to balance benefits and risks.
- Non-drug interventions are key for reducing total cardiovascular risk.
- Tailored treatment strategies are necessary, especially for patients with existing coronary disease.
Abstract:
Today it is considered a primary goal to reduce morbidity and mortality from stroke. It will probably also be possible to reduce other pressure-related illnesses, such as heart failure and renal failure. Coronary morbidity is influenced to some extent only, and involves risk of over-treatment. There is most probably a J-shaped relationship between achieved reduction of pressure and mortality. Treatment with drugs is considered when diastolic pressures exceed 90 mm Hg, provided that the patient has been observed when treated in other ways than by drugs for several months. If no other risk factors are present, 5-10 mm Hg higher diastolic blood pressure levels can be accepted. However, all patients with diastolic pressure above 100 mm Hg should be treated. In patients with coronary disease it is advisable not to lower diastolic blood pressure below 85 mm Hg. One should hesitate to give antihypertensive drugs to individuals with high pressures at the doctor's and normal pressures at home. They should preferably receive intense non-drug treatment aimed at reducing total cardiovascular risk.