When is pharmacologic treatment of hypertension indicated?
When an individual’s blood pressure (BP) does not fall below goal after a suitable period of intensive lifestyle modifications, antihypertensive drug therapy is universally recommended. There is general agreement that antihypertensive drug therapy is one of the major reasons for the decline in stroke and coronary heart disease mortality over the past 50 years. Compared to placebo or no treatment, active drug treatment in clinical trials significantly reduced fatal or nonfatal stroke by ∼35%, myocardial infarction by ∼15% to 25%, heart failure by ∼25%, and all-cause mortality by ∼12%. Most meta-analyses suggest that the cardiovascular protective effects of most antihypertensive drug classes can be most easily attributed to their BP-lowering properties, despite the fact that they do so by different molecular mechanisms. However, a large meta-analysis showed that compared with other antihypertensive drug classes, beta blockers more effectively reduce risk of coronary heart disease events in the first several years after myocardial infarction. In addition, the same meta-analysis suggested that calcium channel blockers (CCBs) have less of a protective effect against heart failure compared with several other antihypertensive drug classes.
Frequently updated guidelines are available from the Canadian Hypertension Education Program. Available at: http://guidelines.hypertension.ca/prevention-treatment/ . Accessed October 10, 2016.