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When is taking medication for high blood pressure a good idea?

Last Update: July 1, 2015; Next update: 2018.

Long-term high blood pressure can increase the risk of cardiovascular disease. It can be effectively lowered by taking medication. The individual risk of cardiovascular disease varies from person to person. That is why some people benefit more from treatment with medication than others.

High blood pressure can be lowered in different ways. People whose blood pressure is only a little too high may first try changing some of their habits. If this does not work, or the effect is too small, medication is considered. Other people may opt for medication right away.

Whether it is a good idea to treat high blood pressure with medication does not depend solely on your blood pressure levels. Individual risk of cardiovascular disease is influenced by a number of other risk factors:

Whether it is worth treating your high blood pressure will mostly depend on the following: 

Determining your individual risk of cardiovascular disease

Your individual risk of developing cardiovascular disease is best determined together with your doctor. There are tables and computer programs that can be used to help calculate your risk. Detailed information on specific risk factors is needed for these calculations, including your current blood pressure, cholesterol levels and blood sugar levels.

The resulting estimated risk is generally described in terms of the likelihood of having a stroke or heart attack within the next ten years. The example below illustrates the influence that different risk factors have on a person’s individual risk:

A 60-year-old man – we will call him John – has slightly high blood pressure (142/93 mmHg). He has no additional risk factors for cardiovascular disease. About 11 out of 100 men like him will have a stroke or heart attack in the next ten years.

A different man of the same age, Henry, has the same slightly high blood pressure as John (142/93 mmHg). But he also smokes, has mild type 2 diabetes and his cholesterol levels are a little high. About 33 out of 100 men with these risk factors will have a stroke or heart attack in the next ten years.

Although both men have the same blood pressure, their risk of cardiovascular disease is quite different. So they would not benefit equally from treatment with medication.

Generally speaking, antihypertensive (blood-pressure-lowering) drugs can reduce the risk of cardiovascular disease by about 20 to 30%. For the men in our example, reducing their risks by 20% would mean the following:

In other words: 2 out of 100 men like John will be spared a stroke or heart attack if they take medication for ten years.

  • If Henry takes an antihypertensive, his risk is reduced from 33 out of 100 to about 26 out of 100.

In other words: 7 out of 100 men like Henry will be spared a stroke or heart attack if they take medication for ten years.

So Henry is far more likely to benefit from medication than John is. 

High blood pressure: Benefit of treatment depends on the risk factors - as described in the text

Advantages and disadvantages of treatment in different people

Based on your estimated risk, you can decide whether you would like to have treatment or not. Here it is helpful to ask yourself whether you think the advantages of the treatment outweigh the disadvantages.

The disadvantages include the possible side effects of treatment. But other aspects may also play a role, such as how much time and effort the treatment involves.

Considering the pros and cons of treatment can be a very personal matter. Many people might be more concerned about preventing a heart attack or a stroke than they are about possible side effects of antihypertensive drugs, such as a dry cough. Others might not be willing to take medication for years at a time or put up with the possible side effects.

When does medication have the greatest benefit?

The higher your blood pressure is, the more likely you are to benefit from taking antihypertensive medication. If you have very high blood pressure, the risk of cardiovascular disease is so great that doctors usually recommend immediate treatment with medication. This is the case for systolic blood pressure levels over 180 mmHg.

Blood pressure that is even higher for a time, for example much higher than 200/100 mmHg, can cause symptoms like nosebleeds, headaches or dizziness. But that is quite rare, and those kinds of symptoms will usually be caused by other things. Should you have more serious symptoms that might be a sign of an emergency such as a heart attack or stroke, it is important to keep calm and lie down, and then seek medical attention, or preferably have someone else get help for you. These symptoms include chest pain and vision problems or speech problems.

Sources

  • Absolutes und relatives Risiko – individuelle Beratung in der Allgemeinpraxis (Arriba). Arriba Herz Risikokalkulationsbogen.
  • Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Different antihypertensive drugs as first-line therapy in patients with essential hypertension: final report; Commission A05-09. July 15, 2009  (IQWiG reports; volume 44).
  • Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Drug treatment of hypertension - update search: Rapid Report; Commission A09-04. February 25, 2010 (IQWiG reports; volume 71).
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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