Should Borderline Blood Pressure Cases Take Meds?

Patients Should Not Feel Overmedicated

Doctors often have to choose which conditions to treat more or less aggressively so as not to overwhelm patients with drugs.

"There is the inertia of pushing the dose and the number of drugs to reach a target in a patient population that is initially asymptomatic or also taking many other drugs," Zusman said. "You want to maximize benefits and minimize adverse effects."

Zussman noted the importance of introducing exercise into the daily routine as well as controlling diet, weight and stress to help manage pre-hypertension without medication.

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The study did not take into account the effect of many types of medicines or co-morbid diseases on pre-hypertensive patients because the participants were relatively healthy, non-diabetic adults. Nor did the researchers control the type of medications used.

Lifestyle Change Remains Top Choice for Blood Pressure Control

Dr. Howard Weintraub, clinical director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Medical Center, also pointed out that the lack of diversity in study participants leaves gaps in data on tight blood pressure control in high risk populations such as African Americans, who, at any level of blood pressure, are at greater risk of cardiovascular disease.

Photo: Roger Blumenthal
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Verdecchia said such gaps may all be points at which research on pre-hypertensive patients could continue.

But he added that about 80 percent of the sample population achieved their target. The overall effect was a significant reduction in the rate of left ventricle hypertrophy, the heart muscle thickening that indicates high blood pressure, in the group that was tightly controlled to reduce their systolic blood pressure to below 130.

Also significant was a reduction in the prevalence of several secondary indicators of high blood pressure, including heart attack, heart failure, angina, arrhythmias and kidney failure.

While Verdecchia's data do not have the strength to justify altering guidelines on managing blood pressure developed by organizations such as the National Institutes of Health and American Heart Association, they do give physicians leeway to treat those at risk for hypertension as aggressively as they and their patient wish.

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And even if they are in conjunction with medication, first line treatment will remain suggestions live more healthfully.

"If a patient comes in with pre-hypertension, I'd assess them for other cardiovascularities -- cholesterol, weight, diabetes, family history -- and encourage them to engage in therapeutic lifestyle change," Ogedegbe said. "But [this study] goes to show that treating patients regardless of their blood pressure level can prevent other cardiovascular risk factors."

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