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How many antihypertensives do patients need to achieve a target blood pressure?

Journal of Human Hypertension volume 19, pages 317–319 (2005)Cite this article

When treating blood pressure, guidelines recommend that clinicians aim to achieve a target level.1 However, guidelines give only limited guidance on how many drugs patients may need to take to achieve these target levels. This paper models the effects of treatments in hypertensive patients to produce an estimate of the number of medications hypertensive patients aged 35–74 years might be expected to need to achieve a target systolic blood pressure of under 140 mmHg and a target diastolic blood pressure of under 90 mmHg.

Recent meta-analysis has produced robust estimates of the effects of treatment on blood pressure.2 At standard dose an antihypertensive reduces blood pressure by 9.1/5.5 mmHg in a patient whose blood pressure is 154/97 mmHg; at twice standard dose the effect is 10.9/6.5 mmHg. (See www.smd.qmul.ac.uk/wolfson/bpchol for standard doses of all drugs, eg bendroflumethazide 2.5 mg, atenolol 50 mg.) The effect is proportionately larger in patients with higher blood pressures and proportionately smaller in those with lower. This provides an estimate of the likely effects of treatment on patients. Combined with data on the prevalence of hypertension and the pretreatment blood pressures of hypertensives, it can be used to obtain the best estimate of the number of drugs required to achieve target levels in a typical cohort of patients.

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  1. Department of Public Health & Epidemiology, University of Birmingham, Edgbaston, Birmingham, UK

    T Marshall

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Correspondence to T Marshall.

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Marshall, T. How many antihypertensives do patients need to achieve a target blood pressure?. J Hum Hypertens 19, 317–319 (2005). https://doi.org/10.1038/sj.jhh.1001823

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