MANAGEMENT OF RAISED BLOOD-PRESSURE IN NEW-ZEALAND - A DISCUSSION DOCUMENT

A report to the National Advisory Committee on Core Health and Disabil ity Support Services, New Zealand, on the management of raised blood p ressure recommends that decisions to treat raised blood pressure shoul d be based primarily on the estimated absolute risk of cardiovascular disease rather than on blood pressure alone. In general, patients with a blood pressure of 150-170 mm Hg systolic or 90-100 mm Hg diastolic, or both, should be given treatment to lower blood pressure if the ris k of a major cardiovascular disease event in 10 years is more than abo ut 20%. The results of clinical trials indicate that, at this level of absolute risk, 150 people would require treatment to reduce the annua l number of cardiovascular events by about one. Implementation of thes e recommendations may result in a smaller proportion of people aged un der 60, particularly women, receiving treatment but an increased propo rtion of older people treated. In the absence of specific contraindica tions, low dose diuretics and low dose beta blockers should be conside red for first line treatment, since for only these drug groups is ther e direct evidence of reduced risk of stroke and coronary disease in pe ople with raised blood pressure.