Early Treatment Helps People With Prehypertension

Medication slowed progression to hypertension, researchers say

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By Steven Reinberg
HealthDay Reporter

FRIDAY, May 19, 2006 (HealthDay News) -- People with the early signs of hypertension appear to benefit from early treatment with blood pressure medication, new research shows.

During the four years of the Trial of Preventing Hypertension (TROPHY) study, researchers found that people with prehypertension who received candesartan -- an antihypertensive drug -- had a significantly reduced risk of developing high blood pressure compared with those who received a placebo.

The findings suggest that people with prehypertension should receive treatment to prevent high blood pressure from developing. This concept has caused some controversy, since it would mean treating perhaps millions of people.

In a discussion Friday at the American Society of Hypertension in New York City, the findings and implications of TROPHY were discussed. The research appeared in the New England Journal of Medicine last month.

People with prehypertension can progress rapidly to full blown hypertension and its consequences, said lead researcher Dr. Stevo Julius, an emeritus professor of internal medicine at the University of Michigan. "This study gives us some hope that if you start treating these people early, you may be able to prevent hypertension."

In the study, Julius and his colleagues randomly selected 772 people with prehypertension to receive the antihypertension drug candesartan or a placebo. Over two years, those taking candesartan experienced significant reductions in blood pressure compared with those receiving placebo.

After two years, candesartan therapy was stopped, and all the patients continued on placebo for another two years. During that time, blood pressures in both groups continued to rise, the researchers found.

During the first two years of the study, 13.6 percent of the patients taking candesartan became hypertensive compared with 40.4 percent of those receiving placebo. Over the next two years, 53.2 percent of those who had been taking candesartan became hypertensive, compared with 63 percent of those who had been taking the placebo throughout.

"We have shown the possibility of treating people with prehypertension," Julius said. "We are by no means recommending this. This is the first step; further studies using other drugs are needed," he added.

One of the objections raised to treating prehypertension is the expense of such a program and the fact that insurance might not cover the expense of the medications. "People are spending a lot of money on vitamins or herbs or massages or a number of unproven things, and they are very glad to do so," Julius responded.

Because of the importance of controlling blood pressure, Julius believes that insurance would cover the costs, but, in any case, such a program could be worthwhile.

Another problem is identifying those who would benefit most from a program directed at prehypertensives. The key to identifying those most at risk is simple, Julius said. "Not surprisingly, the biggest identifier is blood pressure," he said. "People who have the highest blood pressure are those most likely to develop hypertension."

One expert thinks that treating prehypertension is important.

"My personal opinion, one that isn't supported by any guidelines, is that, yes, patients with prehypertension should be treated," said Dr. Thomas Giles, a professor of medicine at Tulane University and president of the American Society of Hypertension.

"Most hypertension experts, I believe, think that lowering blood pressure in patients who are at risk is a good thing to do," Giles said. However, Giles doesn't believe that just putting people on drugs is the answer. He thinks that each patient needs to have a personalized treatment program, including lifestyle changes. "There needs to be a precise regimen designed for you," he said.

In an unrelated report at the same meeting, Dr. Michael Doumas, from the Department of Internal Medicine at the University of Athens, in Greece, presented results of a study of 417 women that showed that sexual dysfunction is linked to high blood pressure.

Among 216 women with high blood pressure, 42 percent suffered from sexual dysfunction, compared with 19 percent of the 201 women with normal blood pressure, Doumas said. In addition, 51 percent of the women who had uncontrolled high blood pressure also had sexual dysfunction, compared with 27 percent of the women whose high blood pressure was controlled.

Why this link exists is unclear, Doumas said. "We really don't know very much about sexual dysfunction in women," he added.

More information

The American Heart Association can tell you more about high blood pressure.

SOURCES: Stevo Julius, M.D., emeritus professor, internal medicine, University of Michigan, Ann Arbor; Thomas Giles, M.D., professor, medicine, Tulane University, New Orleans, and president, American Society of Hypertension; Michael Doumas, M.D., Department of Internal Medicine, University of Athens, Greece; May 17, 2006, presentation, American Society of Hypertension annual meeting, New York City

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