Published 29 June 2009, doi:10.1136/bmj.b2601
Cite this as: BMJ 2009;338:b2601

Letters

Drug prevention of hypertension

Up to a point

The first 150 words of the full text of this article appear below.

This debate parallels that on statins and cholesterol.¹ Lowering low density lipoprotein (LDL) cholesterol, like lowering blood pressure, will almost always lower the risk of cardiovascular events, and the relative risk reduction will be similar regardless of starting blood pressure or LDL concentration. But the absolute risk for people with say a systolic blood pressure of 135 mm Hg and no other risk factors is very low, and you will have to treat scores if not hundreds of people like this for several years to prevent one event.

Many hypertensive patients are not keen on any sort of drug treatment, even with systolic pressures well above 160 mm Hg. How can we persuade people to take any drug when their blood pressure is 30 mm Hg lower?

Antihypertensive drugs are not totally innocuous. Serious and dangerous adverse effects are rare but unpleasant and inconvenient ones are common and can put . . . [Full text of this article]

¹ Imperial College London, St Mary’s Hospital, London W2 1NY

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Authors’ reply

Malcolm Law, Joan K Morris, and Nicholas Wald
BMJ 2009 338: b2602. [Extract] [Full Text]

Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies

M R Law, J K Morris, and N J Wald
BMJ 2009 338: b1665. [Abstract] [Full Text] [PDF]

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