Revisiting the pre-hypertension debate: Increasing evidence for treatment – or not?

The editors of Blood Pressure have contacted Gordon T. McInnes and asked for a rebuttal to the paper by Reed et al. (1) and received the following response:

The paper by Reed et al. (1) provides no worthwhile new evidence to support pharmacotherapy (in otherwise healthy people with pre-hypertension, cursive added by editors). The authors’ argument is essentially the same as that made by Kiely et al. (2) in 2009. I would find it difficult to add to my earlier rebuttal (3).

The editors of Blood Pressure, although accepting the paper by Reed et al. (1) for publication inasmuch as it is nicely reviewing many studies showing high cardiovascular risk associated with pre-hypertension and high normal blood pressure, would like to extend the reservation expressed by Gordon T. McInnes in his letter response to the editors. We herewith in the paragraph below repeat the abstract written by Gordon T. McInnes in 2009 (3).

People with pre-hypertension undoubtedly have an increased risk of cardiovascular and other complications. The vast majority have low absolute risk and whether drug treatment would be beneficial is uncertain. While pharmacotherapy has attractions from a public health prospective, clinicians and crucially those with pre-hypertension require robust evidence that drug treatment will lead to short-term as well as long-term gains. Any changes in recommendations should await adequately powered outcome studies, which provide solid evidence of the magnitude of absolute risk reduction in treating pre-hypertension and assessment of the cost-effectiveness.

The editors of Blood Pressure favor awaiting results from randomized outcome trials before changing clinical practice. Thus, the editors share the view expressed by Gordon T. McInnes regarding drug treatment of pre-hypertension.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.