Pharmacotherapy in young patients with hypertension and no other risk factors

Dr Giuseppe Mancia is an emeritus professor of medicine at the University of Milano-Bicocca (Italy) and past president of the International Society of Hypertension and the European Society of Hypertension.

When should we start pharmacotherapy in young patients with hypertension and no other cardiovascular risk factors?

Giuseppe Mancia, MD, PhD: The threshold for drug treatment, regardless of the level of risk and presence or absence of organ damage, is equal to or above 140 over 90 mm Hg.

There is another citation in the guidelines in favor of starting treatment at an early phase. This is a very nice meta-analysis which showed that, as mentioned in the past, the greater the cardiovascular risk, the greater the number of events saved by antihypertensive treatment. This led to a wrong interpretation, mainly by economists, that it is more convenient to apply antihypertensive drug treatment to high-risk patients because it will [prevent] more events.

This new meta-analysis showed that this is true, that more events are [prevented] in high-risk as compared to low-risk patients, but in high-risk patients the residual risk is disproportionately high, which means that the protection by treatment is incomplete.