The Benefits vs the Risks of Hypertensive Treatment

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Is Blood Pressure Always a Lifestyle Issue, or is it Genetic?

On Sunday November 18, 2018 there was an article from the People’s Pharmacy which discussed the difference between the standard numbers indicating hypertension and the need for medicines to treat them. The article focused on a comparison of the numbers used in America and those used in Great Britain.

This week we are going to discuss those concepts and the underlying philosophy of treatment as recommended by the study just released in England. American doctors generally say that most studies recommend that we should get our bp to 130/80.  And they recommend that we do that if we can by exercise and diet, what are essentially lifestyle habits and choices. However, there are individuals who do exactly this and for whom bp numbers remain too high.

Is BP always a lifestyle issue or is it genetic?

In the Post Dispatch article there was a story of a 34-year-old truck driver who obtains regular physicals and usually has a bp range of 145-55/80-85.  He is urged to exercise regularly eat less salt and lose weight. He is not on bp meds at this point but after having lost 90 lbs. and following an exercise regimen he still has bp concerns.

The first point we want to make is that for some people bp is not a lifestyle choice issue it is a hereditary and genetic issue.

To Treat or not to treat, how is the decision made?

The article goes on to discuss recent data from a study in Great Britain. This study covered 38,000 people over the period Jan. 1998 to September 30, 2018. The short answer is that they did not see any statistical difference in mortality or stroke rates between people who were medicated for bp and those who were not in a category of bp range 140/90 and 155/95. The study looked at equal size groups of people who were medicated and those who were not.

There were however some data that suggested secondary concerns for hypotension, syncope and acute kidney injury for those who were placed on bp medicines.

The extended JAMA article goes into significant detail measuring the data on 38,000 people. Their conclusions are focused on distinctions that need to be made in the definitions of mild hypertension and high-risk hypertension.

There are also discussions regarding the topic of treating patients to obtain a score on a normal scale or treating them to reduce symptoms and including a look at overall happiness and satisfaction of the patients regarding their quality of life.

The concluding point is that for those (particularly younger) people identified as mildly hypertensive, we should perhaps not rush into medicating them. We should first work on lifestyle choice redefinition and we should track them over time to see if they move into the strongly hypertensive range that definitely does need medical intervention.


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