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In response to the BMJ article ‘Cochrane review finds no proved benefit in drug treatment for patients with mild hypertension’, the Blood Pressure Association makes the following response.
Speaking on behalf of the Blood Pressure Association, Professor Gareth Beevers issued the following comment:
“The findings of this Cochrane review are that there is no medium-term benefit (5 years) from treating mild hypertension (140-159/90-99) in patients with no evidence of cardiovascular end-organ damage.
"This is in keeping with the 2011 NICE guidelines which recommend the threshold 160/100 for starting treatment in patients with no CVD (cardiovascular disease) or diabetes.
“This review does not take into account the 'white coat effect' where BPs settle when the patient leaves the clinic. The NICE guidance recommends 24 hr ambulatory monitoring or patient home BP readings to confirm that the hypertension is sustained and in need of treatment. The implications of this Cochrane review and the NICE guidance is that many low-risk patients with mild hypertension are being over treated.
“The other issue is that most of the trials in the Cochrane review used the beta-blocker. The British Hypertension Society and the National Institute for Health and Clinical Excellence (NICE) relegated that class of BP drugs to 4th line 7 years ago. Had more modern drugs been used there might have been a small benefit.
“People with uncomplicated mild hypertension should go on the DASH diet (low salt, low fat, high fruit & vegetable), take plenty of exercise, avoid obesity and limit alcohol consumption).
“There is a danger that some journalists and patients will take this review as evidence that hypertension in general is not worth treating. If lots of patients with severer grades of hypertension with existing CVD stop their tablets, there could be disastrous consequences.”
BPA Trustee Professor Bryan Williams, Director of the Cardiometabolic Diseases Programme at UCL Biomedical Research Centre added,
“This is an analysis emphasing the limited nature of evidence for stage 1 hypertension but does not show that treatment is not beneficial. On the contrary the data suggests a possible halving of stroke risk but the study lacks power to be confident in any conclusions.
“The NICE guidance has already acknowledged the uncertainty of treatment in stage 1 hypertension but does appropriately recommend treating those at higher risk of strokes and heart attacks. Thus in the UK those needing treatment should not discontinue their medication unless advised to do so by their doctor.”
British Hypertension Society President and Past-President of the European Society of Hypertension, Professor Tony Heagerty also stated,
“Trials to establish the effectiveness of drug therapy not only to lower blood pressure but also to reduce risk of circulatory disease (strokes and heart attacks) recruit cohorts of patients with not only hypertension but also declared disease or a high risk factor profile. If they don’t, the study won’t have sufficient statistical power to show any benefit. Such trials generally need 5000 patients or more.
“A trial of mild hypertension where risk is low (of having a heart attack or stroke) would need many thousands of patients to show benefit – more than 20,000 possibly. So a study of 9,000 will have a low chance of showing benefit which is what we have here.
“We need a proper trial to address this question which the European Society of Hypertension has been trying to get funded without success for 6 years!”
Notes to Editors:
- For further information, please contact Claire McLoughlin at the Blood Pressure Association’s Press Office on 0208 772 4992 or email firstname.lastname@example.org
- The Blood Pressure Association is the UK’s leading blood pressure charity, providing information and support to people with high blood pressure and raising awareness about the prevention of the condition. For more information visit www.bpassoc.org.uk or call 020 8772 4994.