May 28, 2013

Waste & Harm in the Treatment of Mild Hypertension: overtreatment, industry influence

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Cochrane Review, disease mongering, drug industry influence, Iona Heath, mild hypertension

Dr. Iona Heath, a retired general practitioner and member of the UK’s Royal College of General Practitioners, writes in JAMA Internal Medicine‘s “Less Is More” column about “Waste and Harm in the Treatment of Mild Hypertension.” (subscription required for access to full text)

This is a topic that receives very little attention.

After all, who can argue with attempts for early intervention against “the silent killer”? Well, evidence is not a bad argument, writes Heath, a leading voice against disease-mongering.

Excerpts:

“The 2012 COCHRANE Review on “Pharmacotherapy for Mild Hypertension”1 concluded that antihypertensive drugs used in the treatment of otherwise healthy adults with mild hypertension (systolic blood pressure [BP], 140-159 mm Hg, and/or diastolic BP, 90-99 mmHg) have not been shown to reduce mortality or morbidity in randomized clinical trials”
“The Cochrane Review also reports that antihypertensive drug treatment for mild hypertension caused 9% of patients to withdraw owing to adverse effects. Each of these patients has experienced the harm of an adverse effect for no established benefit. The waste in terms of the costs of medication and investigations and the time of both patients and health care professionals is enormous.”
In view of the mounting evidence of both waste and harm, it is well time that we returned to the higher threshold of 160/100mmHg for the pharmaceutical treatment of hypertension in otherwise healthy people. The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure provides a timely opportunity for achieving this, but, with the probable degree of industry entanglement, it seems a remote possibility. However, sooner or later the pharmaceutical treatment of mild hypertension seems likely to be consigned to what the novelist Amitav Ghosh has described as “medicine’s vast graveyard of discredited speculations.”

This is worth noting: I could not find one mainstream news organization that reported on Heath’s article. Why not? Too contrarian? It’s just mild hypertension?

We have news organizations that publish stories about journal articles on case series of 1 to 4 patients and make sweeping proclamations based on these. Then why not this?

ADDENDUM ON MAY 30:

On a Forbes blog, Dr. Peter Lipson challenges Heath’s stance, concluding: “One Cochrane report combining four studies is not about to change the way most of us practice medicine. Given the disease burden caused by high blood pressure, none of us should rush to raise our treatment thresholds. While Dr. Heath raises some interesting points, her call for significantly raising the treatment threshold (to 160/100) should be discarded until stronger evidence supports her ideas.”

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