Doctors should move away from the hypertensive model of care and towards a cardiovascular risk approach when managing blood pressure, according to a Perspective published online by the Medical Journal of Australia.
Professor Mark Nelson from the University of Tasmania wrote that a recent trial in the US pointed towards a blood pressure target of 120 mmHg which, although ambitious, may be beneficial for high-risk individuals.
"The study demonstrated not only that the reduction of systolic blood pressure leads to benefits in decreasing the rates of all-cause mortality and cardiovascular morbidity and mortality, but also that this reduction could be achieved with relative safety, even for older patients."
However, the criticism of the findings reflected an entrenched clinical concept of hypertension: "that there is a magic figure above which you have the condition and below which you do not", Professor Nelson wrote. The findings demonstrated that elevated blood pressure should be treated as a variable risk factor rather than being diagnosed as a dichotomous disease, he argued.
Despite cardiovascular risk factors being the cornerstone of evidence-based guidelines developed by the National Vascular Diseases Prevention Alliance, Australian clinical practice hasn't yet widely adopted this approach. According to Professor Nelson, one way to encourage uptake of absolute cardiovascular risk calculators is for the Pharmaceutical Benefits Scheme to align their prescribing conditions to the approved cardiovascular risk guidelines.
"This would mean that all physicians would need to become familiar with the Australian cardiovascular risk calculator in order to access statins for their primary prevention patients. Once habituated, they may be more willing and able to apply it in the setting of treating elevated blood pressure."
Article: Time to bury "hypertension", Mark R Nelson, Medical Journal of Australia, doi: 10.5694/mja15.01178, published 25 July 2016.