A recent Cochrane Review, published in American Family Physician, looked at four randomized, controlled trials with 8,912 patients, examining the clinical effectiveness of drug therapies for mild hypertension, which was defined as a systolic blood pressure of 140 to 159 mmHg and/or diastolic blood pressure of 90 to 99 mmHg.
The outcomes for the study included overall mortality, stroke, heart attack, and heart failure.
A meta-analysis showed no difference in overall mortality between the treatment and placebo groups. Furthermore, there was no difference between groups in total cardiovascular events.
The authors state, “Patients with mild hypertension have a low baseline risk of cardiovascular disease events and overall mortality. Pharmacologic treatment of mild hypertension for up to five years does not reduce coronary events, stroke, or mortality compared with placebo.”
Hypertension is overdiagnosed and overtreated. But drug therapy for hypertension is a multibillion dollar market, so you can bet that most doctors will prescribe a hypertensive drug for a systolic blood pressure of 140 to 159 mmHg.
Yet while a systolic blood pressure of 150 mmHg is high for a 20-year-old, in a 60-year-old, this blood pressure is normal.
Big Pharma confuses the picture by combining populations of patients with all stages of hypertension, from mild to severe, and looking at outcomes with drug therapies.
There is no doubt that extremely high blood pressures — over 180 mmHg — should be addressed. But for mildly elevated blood pressures, there is no data showing that pharmacologic therapies result in better outcomes.
Drinking plenty of water, eating a healthy diet, and exercise can all help maintain a normal blood pressure.
Posts by David Brownstein, M.D.
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