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News1990April › Blood pressure: it's enough to make your blood boil › April 1990

Blood pressure: it's enough to make your blood boil

What is a 'health condition' that therefore needs drug intervention? Well, it's pretty much what the medical profession defines it to be

What is a 'health condition' that therefore needs drug intervention? Well, it's pretty much what the medical profession defines it to be.

Take, for example, the definition of high blood pressure, or hypertension. New guidelines from the National Institutes of Health in the USA have lowered the risk levels before drug therapy is called for. From now on, in the States at least, 'normal' blood pressure is less than 120/80 mm Hg, a pre-hypertensive state is 120/80 to 139/89, stage one hypertension - and this where the drugs now kick in - is 140/90 to 159/99. Under the old guidelines, 'normal' blood pressure was around 128/80 mm Hg, which is now pre-hypertensive.

Doctors are recommending two drugs to treat this new lower threshold of hypertension - thiazide diuretics and a hypertensive. Unfortunately, some of the drugs recommended cause impotence, a small price to pay, many would agree, to meet the exacting new threshold, and incidentally increase the coffers of the drugs industry.

Fortunately, European levels are more reasonable. So, in those countries, people don't have hypertension nor will they become impotent.

All this moving of the goalposts may be in vain if a new study has anything to do with it. It has discovered that the old-fashioned low-dose diuretics are sufficient on their own to reduce blood pressure. In fact, they are more effective than the new boys on the block, the antihypertensives, which the National Institutes of Health are keen that more of us take.

Researchers studied 42 clinical trials of different antihypertensives, which involved 192,478 patients, and found that none of the new front-line treatments - which include ACE inhibitors, calcium-channel blockers and beta-blockers - was any better than the low-dose diuretics.

(Source: Journal of the American Medical Association, 2003; 289: 2534-44).


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