Hypertension – what’s in a name?

Abstract

Medical students worldwide are still taught that “hypertension” is a disease, and that if a person develops this disease, they now have a major risk factor for cardiovascular diseases (CVD). However, in countless epidemiological studies, the association between blood pressure and vascular diseases has been shown to be continuous and log-linear, and that this association persists well below traditional cut-points that have historically been used to define “hypertension”. Utilising threshold blood pressure values to define the presence or absence of a disease state is a false dichotomy that has resulted in the definition of “hypertension” being a moving target over the past 50 years. Exposing and eliminating this false dichotomy is not just an intellectual exercise or a matter of semantics. While more and more guidelines for CVD prevention adopt the “absolute risk” approach, hypertension guidelines also still persist in most countries, which is detrimental to clinical and public health approaches to CVD control. In this presentation, I will challenge the very notion of hypertension and make the case that until this term is eradicated from the medical vocabulary, huge numbers of high risk individuals will be denied treatment that has the potential to substantially impact on their disease risk. At the same time, many individuals at low risk who may have little to gain will be preferentially treated. This is particularly an issue in resource-constrained environments, where prioritising treatment for those who are likely to benefit the most is critically important. Key to addressing this issue is shifting from a paradigm of hypertension control to one of blood pressure lowering.