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Editor's Correspondence |

Is Hypertension Overtreatment a Silent Epidemic?

Steven Rosansky, MD
Arch Intern Med. 2012;172(22):1769-1770. doi:10.1001/2013.jamainternmed.96.
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I commend Kerr et al1 for their examination of overtreatment of hypertension. This issue has been given minimal attention despite potentially harmful consequences. There are a large number of publications on hypertension treatment, yet, using an Internet search, I found only 11 publications that mention the issue of hypertension overtreatment. The only publication that specifically looked at overtreatment was by Scheltens et al,2 where 41.9% of the treated patients had blood pressures (BPs) below levels recommended by Dutch guidelines.

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December 10, 2012
Eve A. Kerr, MD, MPH; Timothy P. Hofer, MD, MS
Arch Intern Med. 2012;172(22):1769-1770. doi:10.1001/2013.jamainternmed.317.
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The answer is "Yes"
Posted on December 12, 2012
José Marcos Thalenberg
MD, PhD. Head of the Blood Pressure Monitoring Service, Hypertensive Cardiopathy Clinic, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
Conflict of Interest: None Declared

Hypertension overtreatment is closely related to the 'white-coat phenomenon." Hypertension overdiagnosis and poor control when using only office and casual measurements are usual causes of iatrogenic hypotensive effects induced by improper or excessive use of antihypertensive medication, such as falls and episodes of myocardial ischemia in coronary disease due to the J-curve phenomenon for diastolic blood pressure.  These are observed in many important studies (INVEST, Syst-Eur, VALUE, etc) and in our daily practice. In a recent prospective study, we redid the diagnosis for 101 subjects treated for hypertension after drug withdrawal, use of new office measurements and ABPM. We found 28% white-coat hypertension and 9% normotensive people among these presumptive clinically hypertensive subjects, none of them presenting symptoms of hypotension (1). We have considerable evidence to suggest that accurate hypertension diagnosis and control is a world-wide disaster, and -yes!- overtreatment is its logical consequence.

1. Thalenberg JM, Luna-Filho B, Bombig MTN, Francisco YA, Póvoa RMS. Is there a need to redo many of the diagnoses of hypertension? Sao Paulo Med J. 2012;130(3):173-8.

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