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Monday, 31 January, 2000, 14:54 GMT
Controversy over blood pressure drugs

Blood pressure Controlling high blood pressure is vital for good health

More than half a million patients being treated for high blood pressure (hypertension) by GPs could have their medication withdrawn without any ill-effects, according to research.

However, the finding has been hotly disputed by one of the country's leading experts in the field.

In the first major British study of its kind, almost 200 patients whose hypertension was apparently being controlled by drugs agreed to have their medication stopped.

As many as 20% of the 2.7 million patients on treatment nationally might have their medication stopped
British Journal of General Practice report
Regular check-ups for signs of a relapse led to half of the patients resuming medication within three months.

But more than one-in-five (22%) had neither relapsed nor suffered any related problems after three years.

The research was carried out by three GPs - Drs Malcolm Aylett and Paul Creighton, based in Northumberland, and Dr Sanjeebit Jachuk, based in Newcastle upon Tyne.

The patients who took part in the study were all aged 40 to 69 and were registered at one of 18 practices in Northern England which co-operated with the study.

Common ailment

Hypertension is one of the commonest ailments in developed countries and is three times more prevalent than diabetes.

Controlling blood pressure can prevent many strokes and heart attacks.

It is known that diet, smoking and exercise can be significant factors.

The report published by the research team argues that GPs should be encouraged to try withdrawing medication in all patients whose hypertension is under control, unless there are firm reasons for not doing so.

The report states: "If a trial of withdrawal was a more prominent feature of current guidelines the attitude of many doctors to withdrawing medication might change, and as many as 0.54 million (20%) of the 2.7 million patients on treatment nationally might have their medication stopped."

However, the team stresses that patient and doctor co-operation and consent are important, and that patients ceasing medication should be monitored for life.

In addition, non-drug strategies, such as advice on diet, smoking and exercise should always be used.

The research team found that almost one-in-three men (31%) but only one-in-seven women (15%) succeeded at stopping medication.

Nihilistic messages

The last thing we need is this sort of under-powered study spreading inappropriate, nihilistic messages
Professor Neil Poulter, Hypertension expert
The findings were condemned by Professor Neil Poulter, who runs a hypertension clinic at St Mary's Hospital, Paddington.

Professor Poulter said many trials had showed enormous benefit in treating patients with hypertension.

He said as soon as patients came off hypertension drugs, their diastolic blood pressure rose by five millimetres. To many GPs this would appear an insignificant amount, he said, but it actually increased the risk of stroke by 40%, and of coronary heart disease by 25%.

Professor Poulter told BBC News Online: "National statistics show that only 39% of hypertensive patients in the UK have their blood pressure controlled to conservative targets.

"The last thing we need is this sort of under-powered study spreading inappropriate, nihilistic messages."

Professor Larry Ramsey, president of the British Hypertension Society, said it was true that some patients had been placed on hypertension drugs inappropriately.

But he said: "More seriously hypertensive patients might read this research and think that they might not need their treatment. If they stop a small proportion could come a cropper quite quickly."

The research is published in the British Journal of General Practice.

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