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BLOOD PRESSURE REDUCTION -- TOO MUCH OF A GOOD THING?

Although blood pressure reduction is recognized to be an effective strategy for reducing the risk of cardiovascular disease, some studies have raised the question of whether overly aggressive therapy may be dangerous. Support for this hypothesis is provided by this study of long-term outcomes in 1765 patients with mild to moderate hypertension who were enrolled in a hypertension control program during 1973-87. These patients were treated with a modified stepped-care approach that started with hydrochlorothiazide or propranolol as first line drugs until 1981, when newer agents became alternatives.

Thirty-nine myocardial infarctions occurred during an average follow-up period of 4.2 years. The risk of infarction was more than 3 times greater in patients with small (0-6 mm Hg) or large (>17 mm Hg) blood pressure reductions than in those with intermediate (7-17 mm Hg) reductions. There was a similar trend for stroke, but it did not reach statistical significance.

These findings are drawn from a moderate-sized population with a small number of cardiovascular events, and they warrant testing in other populations. Nevertheless, they are consistent with the hypothesis that there is a point at which blood pressure reduction may become counterproductive.

— THL

Published in Journal Watch General Medicine August 22, 1989

Citation(s):

Alderman MH et al. Treatment-induced blood pressure reduction and the risk of myocardial infarction. JAMA 1989 Aug 18 262 920-924.

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