How many drugs is enough?
As a GP I assume these guidelines are aimed at me (1). I have long
been concerned by the increasing pressure to encourage lower and lower
pressures, with incraesing numbers of drugs. I think there is good
evidence for 1 or 2 drugs, perhaps some for 3 drugs, but I am unaware of
any good evidence for more than 3 antihypertensives per patient.
However in general practice we often find patients with BP readings
of 220/120, and these patients do not usually have pressures of 140/85
after just three drugs. If you refer them to a hypertension clinic they
often have more drugs added, sometimes with further lowering of the blood
pressure, but not always.
Is there really any evidence for this practice, or should I be
satisfied that the 30-40 mmHg reduction is of benefit to that individual,
even if not yet in the "target range".
1.British Hypertension Society guidelines for hypertension management
1999:Summary BMJ 1999 vol 7210 p630-635
Competing interests: No competing interests