Reconsidering antihypertensive drugs

One has to be cautious blogging about hypertension and its treatment, because the topic is so literally critical to some people's lives.  Here are some excerpts from a very interesting article in Slate:

A new study is turning decades of medical dogma on its head. A panel of independent experts reports this week that drugs used to treat mild cases of high blood pressure have not been shown to reduce heart attacks, strokes, or overall deaths.

Most of the 68 million patients in the United States with high blood pressure have mild, or Stage 1, hypertension, defined as a systolic (top number) value of 140-159 or a diastolic (bottom number) value of 90-99. The new review suggests that many patients with hypertension are overtreated—they are subjected to the possible harms of drug treatment without any benefit.

The study was conducted by the widely respected Cochrane Collaboration, which provides independent analyses of medical data. The “independent” part is important: The panelists who conducted the analysis don’t take money from drug companies. Since many doctors and professional societies have been promoting treatment for mild hypertension for decades, the astute reader might wonder why this analysis was conducted only recently. The reasons are complex, but in a nutshell, researchers simply never addressed the question: Does treatment of mild hypertension help or harm patients? Instead, many authorities simply assumed that treatment helped, probably because treatment of more severe hypertension has been shown to be beneficial...

A problem known as “disease creep” may explain the Cochrane findings. Disease creep occurs when patients with risk factors for a condition or milder cases are treated the same as patients with severe cases. Most patients with mild disease would do well in any case, so it’s easy for drug side effects to overwhelm any benefit.

Jay Siwek, editor of the journal American Family Physician, notes that disease creep can be seen in the recently created concept of “predisease”—such as “prehypertension” or “prediabetes.” Starting medication in people who have only a risk factor, even before they have any evidence of actual disease, can greatly increase profits by getting more people on medicines for far longer periods of time. 

There's more at the link, which will not be popular reading for Big Pharma.