[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.170.64.36. Please contact the publisher to request reinstatement.
Editor's Correspondence
Dec 10/24, 2012

Is Hypertension Overtreatment a Silent Epidemic?

Author Affiliations

Author Affiliation: Dorn Research Institute, WJB Dorn Veterans Hospital, Columbia, South Carolina.

Arch Intern Med. 2012;172(22):1769-1770. doi:10.1001/2013.jamainternmed.96

I commend Kerr et al1 for their examination of overtreatment of hypertension. This issue has been given minimal attention despite potentially harmful consequences. There are a large number of publications on hypertension treatment, yet, using an Internet search, I found only 11 publications that mention the issue of hypertension overtreatment. The only publication that specifically looked at overtreatment was by Scheltens et al,2 where 41.9% of the treated patients had blood pressures (BPs) below levels recommended by Dutch guidelines.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    1 Comment for this article
    EXPAND ALL
    The answer is "Yes"
    José Marcos Thalenberg | MD, PhD. Head of the Blood Pressure Monitoring Service, Hypertensive Cardiopathy Clinic, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
    Hypertension overtreatment is closely related to the 'white-coat phenomenon." Hypertension overdiagnosis and poor control when using only office and casual measurements are usual causes of iatrogenic hypotensive effects induced by improper or excessive use of antihypertensive medication, such as falls and episodes of myocardial ischemia in coronary disease due to the J-curve phenomenon for diastolic blood pressure.  These are observed in many important studies (INVEST, Syst-Eur, VALUE, etc) and in our daily practice. In a recent prospective study, we redid the diagnosis for 101 subjects treated for hypertension after drug withdrawal, use of new office measurements and ABPM. We found 28% white-coat hypertension and 9% normotensive people among these presumptive clinically hypertensive subjects, none of them presenting symptoms of hypotension (1). We have considerable evidence to suggest that accurate hypertension diagnosis and control is a world-wide disaster, and -yes!- overtreatment is its logical consequence.




    1. Thalenberg JM, Luna-Filho B, Bombig MTN, Francisco YA, Póvoa RMS. Is there a need to redo many of the diagnoses of hypertension? Sao Paulo Med J. 2012;130(3):173-8.

    CONFLICT OF INTEREST: None Reported
    READ MORE
    ×