When Should Blood Pressure Medication be Started?

July 1, 2015 Brigham and Women's Hospital

Recent findings may influence how doctors think about high blood pressure management.

Hypertension (high blood pressure) is the most common risk factor for heart disease and death worldwide, but key questions about management of hypertension have remained unanswered. In a recent study funded by the Harvard Center for Primary Care and published in the British Medical Journal, researchers from Brigham and Women’s Hospital (BWH) examined the outcomes of nearly 90,000 adults with hypertension to pinpoint the precise high-blood-pressure level and critical time points at which intervening was tied to a decrease in the risk of death and/or cardiovascular event, such as heart attack or stroke.

“We were the first to look at these metrics in a large group of patients with hypertension, and our findings may help guide doctors as they think about how to treat patients,” says Dr. Alexander Turchin, a physician and researcher in the BWH Division of Endocrinology, Diabetes and Hypertension and senior author of the paper.

Current guidelines and recommendations for managing the care of patients in the earliest stage of hypertension (systolic blood pressure levels between 140 and 159 mmHg) differ substantially. BWH researchers identified three factors that were tied to greater risk of death or cardiovascular event:

  • Systolic blood level above 150 mmHg;
  • Delays in intensification of treatment;
  • Delays in reassessment of patients.

In patients with systolic blood pressures between 130 and 150 mmHg, the researchers did not detect an increase in risk. Above the 150 threshold, however, the team observed progressively greater risk of an acute cardiovascular event or death. They also found that delays in intensification (increasing dosage or adding in new medications when blood pressure levels rise) were tied to an increased risk of death or cardiovascular event. In addition, the team found that when patients received a reassessment of blood pressure levels more than 2.7 months after medication intensification, risk of death increased. The majority of patients in the study did receive follow-up assessments within this window of time.

“Hypertension is treatable, but it is important to know the optimal blood pressure, the optimal time to intensify treatment, and the optimal time to reassess,” says Turchin. “Our research supports the importance of avoiding delays in treatment and having regular follow-up appointments for patients with hypertension.”

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- Jessica F.
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