Does treating for mild hypertension do any good?
Hoffman, of UCLA, says that it is always possible to dismiss “inconveniently negative” evidence, like that in the Cochrane review, because no study can test every possible dosage or combination of medicines or duration of treatment. Thus it is always technically possible that some untested formula might work. But he calls the Cochrane review “the best evidence currently available” about the effects of drug treatment on patients with mild hypertension and says that its results fit with what is known about diminishing returns—and the potential for dangerous side effects—when treating people with less severe disease. He also objects to the idea of treating “unless and until we know for sure that it’s a bad idea,” suggesting instead that “we shouldn’t subject patients to possible harm unless and until we have reasonably good evidence that it’s worth doing.”
Given the possibility that future trials will identify at best a small, currently nonapparent benefit, it seems clear that the best thing for doctors to do would be simply to tell patients the truth—that while the best current evidence doesn’t support routine treatment of mild hypertension, we really don’t know for sure. But we do know this: Emphasizing far more effective—and evidence-based—approaches, such as exercising, quitting smoking, and following a Mediterranean diet, seems to be a very good idea. And besides, they work. [More]Another conversation I will be having at my annual physical.