Anti-hypertensive pills for everyone?

How about anti-hypertensive drugs as part of your daily routine? British researchers recommend that hypertensive drugs (not one but a combination) be given to everybody starting at a certain age regardless of the fact whether they actually have high blood pressure or not. The logic behind this recommended generalized prophylactic treatment is to avoid cardiovascular events caused by hypertension.

According to Dr Malcolm  Law and Dr Nicholas Wald of the Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University of London,

“Guidelines on the use of blood-pressure-lowering drugs can be simplified so that drugs are offered to people with all levels of blood pressure. Our results indicate the importance of lowering blood pressure in everyone over a certain age, rather than measuring it in everyone and treating it in some.”

This means that we should swallow a daily cocktail of anti-hypertensive drugs just like we are swallowing vitamins or nutritional supplements.

The researchers based their recommendations on a meta-analysis of 147 randomized trials that included a total of 958,000 people. The same researchers also supported the so-called polypill which contains 5 different cardiovascular drugs that include:

• a statin
• three anti-hypertensive drugs
• aspirin

The results of the meta-analysis showed that:

• People aged 60 to 69 benefit from taking hypertensive drugs regardless of blood pressure measurements.
• A combination of three drugs at half standard dose (as in the polypill) reduced the risk of coronary heart disease by approximately 46% and of stroke by 62%.
• A single antihypertensive agent at standard dose had about half the effect of the polypill

Currently, there are five main classes of blood-pressure-lowering drugs, namely:

• beta blockers
• thiazides
• ACE inhibitors
• angiotensin-receptor blockers
• calcium-channel blockers

All drugs except calcium-channel blockers were similarly effective in preventing cardiac events and strokes. The calcium-channel blockers seem to have a greater preventive effect against stroke compared to the other drugs.

Other health experts, however, are not so convinced about the arguments and the results of the meta-analysis. They question a lot of assumptions and as well as analytical methods that may not be valid. According to Dr. Franz Messerli of St Luke’s-Roosevelt Hospital Center, New York City

“A meta-analysis is like a sausage; only God and the butcher know what goes in it, and neither would ever eat any.”

Indeed, the idea of prescribing anti-hypertensives for everybody is hard to sell. It is true that hypertension can lead to cardiac events and strokes but there are factors aside from blood pressure play a role as well. Besides, many of the risk factors for cardiovascular disease are lifestyle, and therefore, modifiable factors.

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