Pill’s don’t help against mild Hypertension?

Medication For Four To Five Years In Vain, Says Study

Malathy Iyar

Mumbai: It’s a potential bombshell in the medical arena. A new study suggests that people with mild hypertension – a reading of 140/90mm – should not be popping daily pills to control their condition. In India where every fifth, if not every fourth, grown-up person is a hypertensive, this radical thought could further raise blood pressure.

Has all the pill- popping been in vain? A Cochrane Review published recently certainly has concluded as much: there has been no reduction in deaths, incidence of heart disease or stroke even after four five years among 9,000 patients who have of taking medication for four to five years. The prestigious Review journal said that it had reviewed data from four randomized trials conducted in the United Kingdom, Australia and the United States to arrive at its conclusion.

The patients who were reviewed  had systolic blood pressure between 140 and 159 mm Hg and diastolic reading between 90 and 99 mm Hg. This is classified across the world, including India, as mild hypertension (see box). There have, of course, been allegations from health activists that the hypertension definition has been manipulated in such a manner that the pharmaceutical industry can sell its medication to the maximum number of patients.

But hypertension or elevated blood pressure cannot be taken lightly. It can, over a period of time, wreak havoc with one’s system. It increases a person’s risk for heart disease, stroke, kidney, disease and even blindness. Predictably, most doctors here are upset with the Cochrane review. “It’s review and not an actual study on the effects of medication,” said endocrinologist Shashank Joshi, who has conducted pan- India study on the incidence of diabetes and hypertension. Many western reports on the review suggest that newer medications were not included in this review. The UK Blood Pressure Association’s professor Gareth Beevers said in his statement: “There is a danger that some journalists and patients will take this review as evidence that hypertension in general is not worth treating. If lots of patients with servers grades of hypertension with servers grades of hypertension with existing CVD stop their tablets, there could be disastrous consequences.”

This fear is shared by Indian doctors. Dr Anoop Misra from Fortis Hospital in Delhi felt is too early to consider changing the course of therapy of mild hypertension.  “The trails considered in this review were done only up to five years, while consequence of mild hypertension may appear only after decade or later,” he said. Moreover, he felt that Indians may have different results with drug treatment of mild hypertension. “I suspect our results are more positive than those seen in Caucasians,” said Dr Misra, who is also associated with diabetes foundation of India.

In India, the hypertension picture becomes more serious when one considers the epidemic of diabetes; their combination is certainly more dangerous than their occurrence in isolation. Diabetes affects 61 million Indians, according to 2011 figures. “Given the burden of diabetes and hypertension in the country, we should have more vigorous and aggressive treatment,” said cardiologist N O Bansal, who heads the department in JJ Hospital’s medical school.

Moreover, in India, a sizeable number of patients don’t know that they are suffering from hypertension. Dr Shashank Joshi, who consultants at Lilavati Hospital in Bandra, said “The rule of halves still holds true in India. Approximately half of the patients are undetected, are not treated, and that half of those treated have failed to get their disease in control,” he explained. In other words, the epidemic in India is still silent and undetected in many patients. The question of overmedication hence doesn’t arise, feel experts.

While some feel over medication can cause side effects, Dr Bansal said that there is no dispute in the fact that anti – hypertensive medication helps reduce stroke, kidney and heart failure among patients. “We know that these medications don’t help reduce the burden of is chemic heart disease because many factors contribute to heart disease,” he said.

Thank You,

TIMES NATION 02-SEPTEMBER-2012