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Point of view: why hypertension is overdiagnosed and overtreated in 1987
1University Department of Medicine, Greenslopes Hospital, Brisbane, Queensland, Australia.
Insights
Accurate blood pressure (BP) management requires sufficient data, often lacking in clinical settings. Home BP monitoring provides this data, enabling informed decisions and potentially reducing medication needs for mild hypertension.
Area of Science:
- Cardiology
- Hypertension Management
- Preventive Medicine
Background:
- Clinical decisions on blood pressure (BP) often rely on limited data, influenced by factors like doctor presence and patient position.
- Traditional BP assessments may not capture true BP variability, leading to potential over or under-treatment.
- Aggressive BP reduction is pursued due to concerns about stroke and heart attack, despite incomplete treatment correction.
Purpose of the Study:
- To highlight the inadequacy of current clinical data for diagnosing and managing hypertension.
- To advocate for improved methods of BP data collection for better patient management.
- To explore the role of self-measurement BP units in guiding treatment decisions.
Main Methods:
- Review of current practices in BP assessment and management.
- Discussion of limitations in traditional office-based BP readings.
- Introduction of home BP monitoring using newer, accessible devices.
Main Results:
- Office BP readings can be unreliable due to variability and the 'white coat' effect.
- Self-measurement BP units offer a cost-effective way to gather sufficient, reliable data.
- Normal home BP, including lying diastolic measurements, supports withholding medication in mild hypertension cases.
Conclusions:
- Sufficient BP data is crucial for accurate diagnosis and effective management.
- Home BP monitoring empowers informed decisions, potentially reducing unnecessary medication.
- Non-drug therapy and accurate self-monitoring can mitigate long-term drug-related side-effects.
Abstract:
1. The decision whether arterial blood pressure (BP) is elevated or normal is usually based on inadequate data: few readings in the presence of great variability of BP; levels higher in the presence of the doctor; and diastolic BP often higher sitting and standing than lying. 2. Assessments of response and of the need for increases in drug dosage are also based on insufficient data. 3. Increased morbidity and mortality from stroke and heart attack, and incomplete correction with treatment have been interpreted as suggesting further benefit from aggressive reduction of BP to 'normal' in all patients. 4. The emergence of powerful drugs with few side-effects, and the promise of lowering office BP to 'normal' as monotherapy, has removed the hesitation to treat 'mild' hypertension. 5. Attempts to lower sitting office diastolic BP to 'normal' have led to increasing drug dosage, dose-related, drug-specific side-effects, and lethargy due to hypotension. 6. Newer self-measurement BP units can be used easily by most patients, cost less than five visits to the doctor and provide a cheap method of obtaining sufficient data on which to base informed management decisions. Supported by normal echocardiographic left ventricular mass, normal 'home BP' (including lying diastolic) permits many mild hypertensives to remain off medications. 7. Non-drug therapy avoids or reduces long-term drug therapy, with its side-effects.