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'Don't just treat high BP ­ treat high risk' GPs urged

GPs should give antihypertensives to patients at high risk of heart attack and stroke, not just those with high blood pressure, says a leading expert.

Following the recent debate fuelled by a Government report recommending giving blood pressure-lowering drugs to all over-55s, Professor Sir Richard Peto, head of the University of Oxford's clinical trials unit, said his message was: 'Don't treat high blood pressure, treat high risk.'

He said GPs should give a combination of drugs ­ including aspirin, statins, ACE inhibitors and diuretics ­ after a stroke or heart attack.

But Professor Bryan Williams, professor of medicine at the University of Leicester and chair of the British Hypertension Society, said this had never been put to the test.

Professor Williams, who is involved in drawing up NICE guidelines on managing hypertension, added: 'We've always treated risk, but whether you should lower the blood pressure of normotensive people at high risk needs to be tested in a clinical trial.'

Professor Peto, professor of medical statistics and epidemiology, said studies at the unit showed that taken together the drugs could reduce the annual risk of a recurrent attack from 7 per cent to 2 per cent.

He said: 'We should be able to knock off two-thirds of the recurrence risk by giving three or four generic pills.'

But he disagreed with treating all older people. 'Medicalising the whole population really does not seem that attractive to me. I am not talking about treating everyone, only those with high risk who have already got some serious disease.'

Current British Hypertension Society guidelines only recommend giving BP-lowering drugs to patients with greater than 100mHg diastolic.

And the new NICE guidelines, due out early this year, are unlikely to change this.

Of the NICE guidelines, Professor Williams said: 'You have to have a threshold of when to treat people.

'Thresholds have progressively fallen over the years to reflect the fact that benefits accrue across the spectrum of pressures.'

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