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Arterial hypertension:
how do you define normal levels?

Defining normal levels to assess risk or to decide on drug treatment is of no value unless the effectiveness of prescribing treatment above these levels is proven.

The massive so-called "consumer information" campaigns on disease being carried out more or less directly by pharmaceutical firms are commercial in nature.

Often, the thresholds above which drug treatment is prescribed for these "illnesses" are lowered to increase the population considered "ill", and therefore "justifying" their treatment with drugs sold by the sponsors of these campaigns.

A case in point is that of arterial hypertension. Blood pressure is a continuous quantitative variable and if it is high, it is an indicator of progressive cardiovascular risk. But these statistical correlations are not sufficient to define thresholds above which the benefit-harm balance of drug intervention is positive. Only clinical trials can confirm in practice the appropriate drug intervention thresholds that are of benefit to patients.

The impact on morbimortality of some antihypertensive drugs has been proven for blood pressure of 160/95 mm Hg in patients without diabetes or complications, and of 140/80 mm Hg in diabetics or post-stroke patients. Currently no proof is available for lower rates.

©Prescrire December 2006

Source: "Hypertension artérielle : quels seuils, pour quoi faire ?" Rev Prescrire 2006 ; 26 (278) : 843.

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