‘No pills for mild BP’ advice sends doctors’ pulse racing

New Study Says Medication For 4-5 Years In Vain Mumbai: It's a potential bombshell in the medical arena. A new study suggests that people with mild hypertension – a reading of 140/90 mm – should not be popping daily pills to control their condition.      In India where every fifth, if not every fourth, adult is a hypertensive, this radical thought could further raise blood pressure.      Has all the pill-popping been in vain? A Cochrane Review published recently has concluded as much: there have been no reduction in deaths, incidence of heart disease or stroke among 9,000 patients who have been taking medication for four to five years. The prestigious Review journal said it had reviewed data from four randomized trials conducted in the UK, Australia and the U S to arrive at its conclusion. Treat BP problems with right medication: Docs  Mumbai: A new study, which suggests that people with mild hypertension – a reading of 140/90 mm – should not pop daily pills for their condition, hasupset mostdoctorshere.      The journal Cochrane Review reviewed data from randomised trials in the United Kingdom, Australia and the United States among 9,000 patients. The patients had systolic blood pressure between 140 and 159 mm Hg and diastolic reading between 90 and 99 mm Hg.Thisisclassified acrossthe world, including India, as mild hypertension. There have, of course, been allegations from health activists that the hypertension definition has been manipulatedin such a manner thatthe pharmaceuticalindustry can sell its medication to maximum number of patients.      Buthypertension or elevated blood pressure cannot be taken lightly. Predictably, most doctorshere areupsetwiththe Cochrane review."It's a review and not an actual study on the effectsof medication," saidendocrinologist Shashank Joshi, who has conducted pan-India study on the incidence of diabetes and hypertension. Many western reports on the review suggest newer medications were not included in this review. The UK Blood Pressure Association's professor Gareth Beevers said in a statement: "There is a danger some journalists and patients will take this review asevidencethathypertension in general is not worth treating. If lots of patients with severer grades of hypertension with existing CVD stop tablets, there could bedisastrousconsequences.''      This fear is shared by Indian doctors. Dr Anoop Misra of FortisHospitalin Delhi,whois associated with the Diabetes Foundation of India, said, "Trials considered in this review were done only up to five years, while consequence of mildhypertension may appear only after da ecade or later. I suspect our results are more positive than Caucasians." "Given the burden of diabetes and hypertension in India, we should have more vigorous and aggressive treatment,'' said cardiologist N O Bansal, who heads the department in JJHospital's medicalschool.      Moreover, in India, a sizeable number of patients don't know they are suffering from hypertension. Dr Shashank Joshi, who consults at Lilavati Hospital in Bandra, said, "Approximately half the patients are undetected, half of those detected are nottreated,halfof those treated failed to get theirdisease in control,'' he said. So the question of overmedication doesn't arise,feelexperts.      Cardiologist Ganesh Kumar from L H Hiranandani Hospital in Powai was the only one who agreed with the Cochrane review. He said, "Many patientssuffer from white-coat hypertension,their blood pressure goesup by merely waiting in thewaiting room of a doctor (who wears a white coat).'' Soblood pressure readings should be repeated over a three-month period before the patientis puton medication.      There is also the role of exercise and diet. Lead reviewer of the Cochrane Review, David Cundiff, was quoted saying: "Patients focus on exercising, smoking cessation, and eating a DASH (diet against systolic hypertension) or a Mediterranean diet.''