Blood pressure drugs 'failing patients': Celia Hall reports from the 14th Congress of the European Society of Cardiology in Barcelona

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The Independent Online
A BRITISH cardiologist warned yesterday that drugs used to reduce high blood pressure brought no benefit to most patients, but had substantial costs and side-effects.

Dr Stanley Taylor told the congress that patients would derive more benefit from returning to work or even taking placebo ('dummy') pills for hypertension.

The cost-benefit ratio of blood pressure-reducing drugs may be very low indeed while the side-effects included gout, lethargy, impotence and Raynaud's disease.

But there were still benefits from reducing risk factors for heart disease and strokes by not using drugs - a two to three-mile brisk walk had been shown to reduce blood pressure, he said.

'If we could persuade our patients to take these risk-avoiding actions: to drink only a limited amount of alcohol; to eat a low-fat diet; to take a little more exercise and control their weight, they could achieve great benefit. The cost is virtually nil, and they may even save money without any cost to the community at all.'

Dr Taylor, a retired senior lecturer in cardiology, said that if we were to use drug therapy, benefits must outweigh the costs but that there was little proof that they did.

He said that blood pressure-reducing drugs had been shown to achieve a reduction in deaths from stroke of 40 per cent, but only 10 to 15 per cent reductions in deaths from heart attacks.

He costed the five main groups of drugs used to treat patients. To treat 1,000 patients for a year with diuretics cost pounds 500; by using beta- blockers the cost would be pounds 60,000; calcium antagonists cost pounds 120,000; and for Ace inhibitors the cost was around pounds 250,000.

But only one stroke would be prevented by the use of drugs in this calculation, and since they were less effective for heart disease it would take three to four times these sums to prevent a single heart attack. 'We want to treat people with severe blood pressure but with the huge group with mild hypertension we sould be debating how much and to what extent we treat people with drugs.'

Professor Desmond Julian, medical director of the British Heart Foundation, commenting on Dr Taylor's talk, said that in Britain about a third of elderly people took diuretics. 'The general standard of treating high blood pressure is not good in Britain. Until relatively recently few people even had their blood pressure taken,' he said.

About 15 per cent of Britons had high blood pressure but mostly the condition was mild, Professor Julian said. 'For the average patient a doctor should just watch his patient and recommend some lifestyle changes. Alcohol is an important issue and weight loss is an obvious target. I am sure some GPs do go for drugs at too early a stage.'