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Study warns of danger of treating raised BP alone

Diagnosing hypertension on the basis of blood pressure measurements alone leads to massive over-treatment, particularly of younger patients, a new study concludes.

The study leader, an advisor to NICE on public health, warned current practice breached a central tenet of the Hippocratic code by failing to 'first do no harm'.

Dr Tom Marshall, clinical

lecturer in public health at the University of Birmingham, urged GPs to instead base decisions about treatment on cardiovascular risk assessments. He said GPs should only treat hypertension in the absence of other risk factors when blood pressure was extremely high – suggesting a 180/110mmHg threshold for younger patients.

The data analysis on 4,763 US adults – to be published in Medical Decision Making – compared diagnosis of hypertension based on two separate blood pressure measurements with more rigorous, repeated assessment.

Fewer than 40 per cent of men under 35 and only 25 per cent of women under 35 who tested positive for hypertension actually had the disease.

Just over half of those aged 35 to 55 who tested positive had the condition, although here the risk-benefit balance of treatment was better.

But Professor Morris Brown, professor of clinical pharmacology at the University of Cambridge, said: 'Untreated mild, younger hypertensive patients of the past fill our hypertension clinics decades later.'

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