High blood pressure – When is medication an option?

Most people who have high blood pressure do not realize they have it. Yet it can cause damage to blood vessels over the years, increasing the risk of heart attacks and strokes. Blood pressure is considered to be high if the upper value is more than 140 or if the lower value is more than 90.

If you have high blood pressure, you may wonder what you can do about it. In milder cases, getting more exercise and changing your diet can already help lower your blood pressure to a normal level. In more severe cases, you may need to take medication too, particularly if you have other risk factors for cardiovascular disease.

What are the risk factors for cardiovascular disease?

Blood pressure is not the only factor that determines your risk of cardiovascular disease. Things like smoking, being overweight, having type 2 diabetes and high cholesterol play a role too. The risk generally increases with age. Cardiovascular disease is slightly more common in men than it is in women. Genes play a role too. For instance, your risk is higher if your brother or father had a heart attack or stroke under the age of 55, or your sister or mother had a heart attack or stroke under the age of 65.

How is your risk assessed?

Your individual risk can only be properly assessed by considering all of the risk factors together. This is best done together with a doctor. Special risk assessment tools, such as questionnaires or computer programs, can help you do this. A questionnaire called ARRIBA is often used in Germany. The outcome will be different for women and men with the same blood pressure levels because your sex plays a role too.

Why do you need to know more than just blood pressure?

The following example illustrates why blood pressure alone is not enough to assess your risk properly: Same blood pressure, different risk. John is 60 years old and has slightly high blood pressure, with readings of 142 over 93. He does not have any other risk factors for cardiovascular disease. Henry is also 60 years old. His blood pressure readings are the same as John’s, but he smokes, has mild type 2 diabetes and his cholesterol is a little too high.

John has a significantly lower risk of cardiovascular disease than Henry: About 11 out of 100 men whose only risk factor is slightly high blood pressure will have a stroke or heart attack in the next ten years - compared to 33 out of 100 men who have the same risk factors as Henry. So, although both men have the same blood pressure, their risk of cardiovascular disease is quite different.

When does medication for high blood pressure help? Blood-pressure-lowering drugs can reduce the risk of cardiovascular disease by about 20 to 30 percent. In John’s case, a 20 percent risk reduction would reduce his personal risk from 11 out of 100 to 9 out of 100. In other words: if 100 men like John take medication for high blood pressure over ten years, 2 of them will be spared a stroke or heart attack.

If Henry takes medication to lower his blood pressure, his risk will also decrease by 20 percent – from 33 out of 100 to about 26 out of 100. In other words: if 100 men like Henry take medication for ten years, 7 of them will be spared a stroke or heart attack. So they are quite a lot more likely to benefit from taking medication.

How do I decide?

But the expected benefits are only one of the factors to consider when deciding whether or not to have treatment. Medication for high blood pressure can have side effects, and many people would prefer to avoid medication for as long as possible. Others are more focused on preventing a heart attack or stroke. They will be more willing to accept the possible side effects of medication.

Whether or not to take blood-pressure-lowering medication is a personal decision. You must ask yourself whether the possible benefits of taking medication are worth the associated risks. It is important to have an honest talk about the pros and cons of treatment with your doctor.

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