Treatment Recommendations for Hypertension

The next issue of Treatment Guidelines from The Medical Letter will be on Drugs for Hypertension, a subject that has drawn considerable attention lately in general medical journals and in the public media. The primary focus in the media has been on the less restrictive blood pressure targets for older patients and those with diabetes and chronic kidney disease recommended recently by the Eighth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8). An article in the April 9th issue of the Journal of the American Medical Association (JAMA) looked at how many fewer patients would be treated for hypertension if US physicians followed the JNC8 recommendations rather than the more restrictive recommendations of JNC7. But the authors of the JAMA article noted that not all of the JNC8 committee members agreed with the new recommendations.

Blood pressure targets are not the only area of disagreement among hypertension guideline writers. In preparing our article, we considered guidelines from 6 different organizations: 3 from the US, 2 from Europe, and 1 from Canada. And their recommendations are not all the same either. What is the poor practitioner to do?

The Medical Letter has always tried to tailor its treatment recommendations to the individual healthcare provider sitting across from an individual patient. All practitioners are not the same in their prescribing habits, and all patients are not the same in their needs. For example, some patients who no longer need treatment according to the new JNC8 guidelines, but have been taking the same drug for years with no ill effects, might be best served by staying on it. And some patients with hypertension whose blood pressure is well controlled by a beta blocker with no side effects probably should not switch to one of the drugs that some of the guidelines now prefer. So we try to make reasonable recommendations that incorporate a thoughtful consensus of the various guidelines, leaving room for some individual variation. To see the details, take a look at our Drugs for Hypertension in the May issue of Treatment Guidelines from The Medical Letter.

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