Study Spurs Discussion About Blood Pressure Treatment Guidelines
By Denise Mann
WebMD Health News
Reviewed by Laura J. Martin, MD
Dec. 8, 2011 -- If your blood pressure is higher than normal, but not high enough to be considered high blood pressure, then you have prehypertension. And that means you may have a higher risk for stroke and heart disease.
Now, new research shows that blood pressure-lowering pills may help lower the risk of stroke in people with prehypertension.
More than 50 million Americans have mildly elevated blood pressure or prehypertension. It is defined as systolic blood pressure (the top number) between 120 and 139 or diastolic blood pressure (the lower number) between 80 and 89. High blood pressure is defined as 140/90 mm Hg or higher.
High blood pressure (hypertension) is major risk factor for stroke and heart disease. It is treated aggressively with lifestyle changes and medications. The American Heart Association encourages lifestyle changes, not drugs, for people with prehypertension. This includes losing weight (if necessary), eating a healthy, low-salt diet, exercising regularly, and quitting smoking.
Medication Lowers Stroke Risk
Adding blood pressure-lowering drugs to lifestyle changes may prevent more strokes in people with prehypertension, according to the new research.
Researchers reviewed 16 studies of more than 70,000 people with prehypertension who were treated with blood pressure medication or a placebo. Those who took blood pressure-lowering medications were 22% less likely to have a stroke, compared with those who did not. The findings appear in Stroke.
"If lifestyle changes do not fix your prehypertension, then [medication] can help reduce your blood pressure and your stroke risk," says researcher Ilke Sipahi, MD. Sipahi is an assistant professor of cardiovascular medicine at Case Western Reserve University in Cleveland, Ohio.
"We think that our findings need to be discussed extensively ... before a change in guidelines is implemented," Sipahi says via email. "For the prehypertensive patient with additional risk factors for stroke, such as high cholesterol or smoking, [medication] can be very helpful to reduce the risk, especially if blood pressure levels do not normalize with lifestyle changes."
Treat With Diet Changes First
Outside experts say there is not enough evidence to warrant a shift in the guidelines ... yet.
"Prehypertension is important for physicians to recognize and begin treating with lifestyle modifications," says Ralph Sacco, MD. He is chairman of the neurology department at the Miller School of Medicine at the University of Miami. "It is still not totally clear whether we should be jumping to provide medicine to all people with prehypertension."
Medication is costly and does come with its share of side effects.
Risk factors that may tip the scales in favor of adding blood pressure-lowering medication include history of heart disease, diabetes, or mini-stroke, he says.
"We are not ready to change anything," says Gordon F. Tomaselli, MD. He is the chief of cardiology at Johns Hopkins University in Baltimore, and president of the American Heart Association. "For prehypertension, we use lifestyle measures first and hold off on medications to allow for these measures to take hold."
Lifestyle changes are the cornerstone of prevention, he says. But new guidelines due out in early 2012 from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure may sway the debate toward earlier use of medication, he says.
Samuel Mann, MD, treats high blood pressure at New York-Presbyterian/Weill Cornell Medical Center in New York City. Most of the participants in the new study had other risk factors for stroke besides prehypertension, he says. "It may not be cost-effective to treat people with drugs if their only risk factor for stroke is prehypertension."
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SOURCES: Sipahi I, et al. Stroke. 2011. In press.Ilke Sipahi, MD, assistant professor of medicine, Case Western Reserve University, Cleveland.Samuel Mann, MD, cardiologist, New York-Presbyterian/Weill Cornell Medical Center, New York City.Ralph Sacco, MD, chairman, neurology department, Miller School of Medicine, University of Miami.Gordon F. Tomaselli, MD, chief of cardiology, Johns Hopkins University, Baltimore.
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