Do benefits outweigh the risks in antihypertensive therapy?

Despite tremendous advances made In the treatment of hypertension, It IS stili an area where drug-related adverse effects lead to poor compliance and sometimes serious complications. The risks of the condition must be weighed up against the risks of the treatment, and especially how It will affect the patients quality of life. Whereas moderate to severe hypertension warrants treatment and patients will often accept side effects, the benefits of treating mild asymptomatic hypertension are not always eVident especially to the patient.

The 'stepped-care approach' where step 3 and 4 drugs are only used when there IS no response to the less potent step 1 and 2 drugs, alms to provide optimal treatment with the least side effects. Thiazide diuretics and beta-adrenoreceptor blocking drugs (used In steps 1 and 2) have well documented side effects, but the risks are comparatively low. Methyldopa is stili used widely as a step 3 agent, despite its centrally mediated side effects. Step 3 agents used currently with few side effects Include calcium antagonists, e.g. nifedlpine, and angiotensin converting enzyme Inhibitors e.g. captoprll. The side effects experienced by many patients taking captopril when it was first Introduced (skin rash, taste disturbances, neutropenia, proteinuria) are now rarely reported: It was found that the same therapeutic response could be achieved with a lower dose than was first used. In one study, patients taking captopril scored higher In tests of well-being than those taking propranolol or methyldopa.

Non-drug measures should be used where possible In mild hypertension, and when they are necessary, drug regimens should be chosen carefully. Thus 'with care, the risks of antihypertensive therapy are considerably less than the benefits'.

Lancet 2 1075-1076, 8 Nov 1986

2 Reactions@ 20 Dec 1986 0157-7271/86/1220-0002/0$01.00/0 © ADIS Press