When is taking medication for high blood pressure a good idea?
Over time, high blood pressure increases the risk of cardiovascular disease. Medication can lower blood pressure effectively. The higher the blood pressure, the greater the benefit. But the risk of long-term health consequences also depends on many other factors.
A decision to take medication for high blood pressure is a long-term decision. So it's worth considering the pros and cons of the various treatment options. If you would like to know about the advantages and disadvantages of different treatments, doctors are obliged to describe them to you – and everyone has the right to decide for themselves whether or not to take medication to lower their blood pressure (antihypertensive medicine).
Slightly high blood pressure can often be reduced by losing weight, eating less salt and getting more exercise. If that isn't effective enough, treatment with antihypertensive medication is considered. Some people may opt for medication right away.
What factors increase the risk of heart and circulation problems?
Whether it is a good idea to treat high blood pressure with medication doesn't only depend on your blood pressure levels. Your individual risk of cardiovascular disease is higher if
- you are older,
- you are male,
- you are overweight,
- you smoke,
- you have type 2 diabetes,
- you have high cholesterol levels, and if
- it runs in your family: People are at higher risk if they have a brother or father who already had a heart attack or stroke under the age of 55, or a sister or mother who had a heart attack or stroke under the age of 65.
Whether it is worth taking medication for high blood pressure will depend on the following:
- How high your blood pressure is
- What additional risk factors you have
- How important the advantages and disadvantages of the treatments are to you
What is my risk?
Your individual risk of developing cardiovascular disease can be determined together with your doctor. You will need to consider the exact details of the individual risk factors, and determine your current blood pressure, cholesterol and blood sugar levels. This information is entered into a computer program that calculates your risk level. The calculation is based on data from studies that observed many thousands of people for years.
You will get a percentage showing your likelihood of having a stroke or a heart attack within the next ten years.
Example: Two men – two risk levels
Imagine two men: John and Henry. Both of them are 60 years old, and both have slightly high blood pressure levels of 142/93 mmHg.
- no other risk factors.
- The probability that he will have a heart attack or a stroke within the next ten years is 11%. That means that 11 out of 100 men with the same risk as John will have a heart attack or stroke in the next ten years.
Henry, on the other hand,
- has mild type 2 diabetes and
- poor cholesterol levels.
- The probability that he will have a heart attack or stroke within the next ten years is three times as high as the likelihood that John will: It is 33%.
This risk calculation shows that although the two men have the same blood pressure levels, their individual risk of cardiovascular disease is very different.
How does your individual risk influence your use of medication?
Blood pressure medicine can lower the ten-year risk of cardiovascular disease by 20 to 30% of the initial individual risk. For the men in our example, reducing their risks by 20% would mean the following:
- If John takes antihypertensive medication, his risk of having a heart attack or stroke is lowered by 2%: from 11 to 9%. In other words: Strokes or heart attacks are prevented in 2 out of 100 men like John if they take medication for ten years.
- For Henry, a risk reduction of 20% means that the likelihood that he has a heart attack or a stroke drops by 7%: from 33 to 26%. Because Henry's initial risk is much greater than John's, he also benefits more from treatment with medication.
This illustration shows the difference:
What do John and Henry decide?
Together with their doctors, John and Henry have each found out their risk of cardiovascular disease and talked about the next steps.
- has decided not to use antihypertensive medication. He feels healthy and doesn't want to have to take medicine every day – especially since his risk of developing blood-pressure-related health problems would only decrease by 2%. Also, he thinks that his lifestyle is already pretty healthy: He runs several races a year, eats a balanced diet and doesn't drink much alcohol. He tells himself: "If my blood pressure suddenly goes up in a few years, I can still start taking medication then."
- has decided to take medication, but also wants to make a serious attempt to quit smoking. The numbers that his doctor has described to him have made him think things over. He considers a probability of 33% of developing long-term health problems to be very high. When he asked about possible side effects, his doctor assured him that most people tolerate antihypertensive medication quite well.
John and Henry's cases show that deciding whether or not to use medication for blood pressure is a matter of individual choice as well.
When is medication necessary?
The higher your blood pressure is, the more likely you are to benefit from taking antihypertensive medication. If you have very high blood pressure, the risk of cardiovascular disease is so great that doctors usually recommend immediate treatment with medication. This is the case for systolic blood pressure levels over 180 mmHg.
Blood pressure that is even higher for a time, for example much higher than 200/100 mmHg, can cause symptoms like nosebleeds, headaches or dizziness. But that's quite rare, and those kinds of symptoms will usually be caused by other things. Should you have more serious symptoms that might be a sign of an emergency such as a heart attack or stroke, it's important to keep calm and lie down, and then seek medical attention, or preferably have someone else get help for you. These symptoms may include chest pain and vision problems or speech problems.
Arriba. Kardiovaskuläre Prävention: Kardiovaskuläres Risiko berechnen. 2007.
Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Drug treatment of hypertension - update search: Rapid Report; Commission A09-04. February 25, 2010. (IQWiG reports; Volume 71).
Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Different antihypertensive drugs as first-line therapy in patients with essential hypertension: Final report; Commission A05-09. July 15, 2009. (IQWiG reports; Volume 44).
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