More lives could be saved if doctors considered giving blood pressure drugs to all patients at high risk of heart disease - even if their blood pressures are normal, a study suggests.
The report calls for a move away from current guidelines which recommend pills only be prescribed if blood pressure is above a certain threshold.
But experts acknowledge lifestyle factors also have an important role to play in bringing blood pressures down.
The study appears in the Lancet.
High blood pressure has long been linked to a higher risk of heart disease and stroke.
Current guidelines - issued by England's
National Institute for Health and Care Excellence
- suggest patients should only take medication when their blood pressure levels reach 140 mmHg.
Until this point even those at highest risk, for example people who have had strokes, are offered monitoring but not pills.
Now a global team of experts are calling for doctors to focus on an individual's risks rather than rigid and "arbitrary" blood pressure thresholds.
Large trial
Experts analysed the results of more than 100 large-scale trials involving some 600,000 people between 1966 and 2015.
They found those patients at highest risk - including smokers with high cholesterol levels and people over 65s with diabetes - would benefit most from treatment, lowering their chance of heart attacks and strokes.
In addition the report suggests once on treatment, blood pressure levels could be reduced even further than the targets currently used.
The study also adds to growing evidence that patients may benefit from lowering their blood pressure whatever their baseline levels - either through lifestyle changes or drugs.
But it shows the lower the person's blood pressure to start with, the lower the benefit they gain from reducing it.
The authors do not go as far as to suggest everyone should be given pills and caution side-effects of medication must be weighed up.
Prof Liam Smeeth, of the London School of Hygiene and Tropical Medicine, agreed the findings were important for those at highest risk.
But he warned: "One important caveat is that not everyone will be able to tolerate having their blood pressure reduced to low levels, and there is a need to balance possible drug side effects and likely benefits."
Heart specialist Dr Tim Chico, of the University of Sheffield, said medication need not be the only way to tackle the issue.
He added: "We can all reduce our blood pressure.
"We can do this safely, cheaply and as effectively as tablets by eating healthily, taking more physical activity, reducing alcohol intake, and maintaining a healthy weight "
www.bbc.com/news/health-35169864

Thanks OP

Resounding findings from a large study but I have my reservations about giving treatment for hypertension to people who are not hypertensive but only have risk factors.

1. There are many risk factors for hypertension, so which ones will be put into consideration? For instance, having hypertensive first degree relatives is a risk factor, so should I be placed on antihypertensives because my mum and dad are hypertensive? Same with age, will all old aged people be placed on the drugs? Definitely NO! So the inclusion criteria is not well spelt out as 'risk factors' is quite vague.

2. Many hypertensive people have had their high blood pressures return to normal without taking any drug but with lifestyle modifications like a low sodium/salt diet, regular aerobic exercise, weight loss etc. So I don't think the first line treatment for people at risk or with the disease should be drugs.

3. For people with modifiable risk factors like smoking, obesity, excessive alcohol intake etc, the emphasis should be elimination of those risk factors (to prevent the hypertension and other diseases) and not treatment of an anticipated hypertension.

My 2 cents.
Thanks for the sharing the article.

looseweight:
Thanks OP

Uw

DrAdonis I agree with you though your reservations were also captured in the pub as quoted :

But experts acknowledge lifestyle factors also have an important role to play in bringing blood pressures down.
The study appears in the Lancet.

Now a global team of experts are calling for doctors to focus on an individual's risks rather than rigid and "arbitrary" blood pressure thresholds.

The authors do not go as far as to suggest everyone should be given pills and caution side-effects of medication must be weighed up.

But he warned: "One important caveat is that not everyone will be able to tolerate having their blood pressure reduced to low levels, and there is a need to balance possible drug side effects and likely benefits."

I think the focus of this study is in preventing avoidable stroke episodes. Ultimately. it's not a WHO or AHA approved guideline but it could inform our options of management of a stroke candidate.