High blood pressure: When are medications used?

When deciding whether or not to use antihypertensives, it's a good idea to find out about the pros and cons first. This decision aid may help here.

What is my individual risk of developing complications?

The following factors increase the risk of high blood pressure leading to cardiovascular disease:

• Old age
• Being male
• Being overweight
• Smoking
• Type 2 diabetes
• High cholesterol levels
• Family members with cardiovascular disease: People are at higher risk if they have a brother or father who already had a heart attack or stroke under the age of 55, or a sister or mother who had a heart attack or stroke under the age of 65.

Your individual risk of developing cardiovascular disease can be determined together with your doctor. The exact information about the individual risk factors is needed, including your current blood pressure, cholesterol levels and blood sugar levels. This information is entered into a computer program that calculates your risk level. The calculation is based on data from studies that observed many thousands of people for years.

You will get a percentage showing your likelihood of having a stroke or a heart attack within the next ten years.

Example: Two men – two risk levels

Imagine two men: John and Henry. Both of them are 60 years old, and both have slightly high blood pressure levels of 142/93 mmHg.

John has

• no other risk factors.
• The probability that he will have a heart attack or a stroke within the next ten years is 11%. In other words, 11 out of 100 men with the same risk as John will have a heart attack or stroke in the next ten years.

Henry, on the other hand,

• smokes,
• has mild type 2 diabetes and
• poor cholesterol levels.
• The probability that he will have a heart attack or stroke within the next ten years is three times as high as the likelihood that John will: It is 33%.

This risk calculation shows that although the two men have the same blood pressure levels, their individual risk of cardiovascular disease is very different.

How does your individual risk influence your use of medication?

Blood pressure medicine can lower the ten-year risk of cardiovascular disease by 20 to 30% of the initial individual risk. In other words: The higher your individual risk of cardiovascular disease is, the more you will benefit from antihypertensive medication.

Assuming an individual risk reduction of 20% means the following for the two men in our example:

• If John takes antihypertensive medication, his risk of having a heart attack or stroke is lowered from 11 to 9%.
• If John takes antihypertensive medication, his risk of having a heart attack or stroke is lowered from 33 to 26%.

This illustration shows the difference:

What do John and Henry decide?

Together with their doctors, John and Henry have each found out their risk of cardiovascular disease and talked about the next steps.

John has decided not to use antihypertensive medication. He feels healthy and doesn’t want to have to take medicine every day – especially since his risk of developing blood-pressure-related health problems would only decrease by 2%. Also, he thinks that his lifestyle is already pretty healthy: He runs several races a year, eats a balanced diet and doesn’t drink much alcohol. He tells himself: “If my blood pressure suddenly goes up in a few years, I can still start taking medication then.”

Henry has decided to take medication, but also wants to make a serious attempt to quit smoking. The numbers that his doctor has described to him have made him think things over. He considers a probability of 33% of developing long-term health problems to be very high. When he asked about possible side effects, his doctor assured him that most people tolerate antihypertensive medication quite well.

John and Henry’s cases show that deciding whether or not to use medication for blood pressure is a matter of individual choice as well.

Sources

• Arriba. Kardiovaskuläre Prävention: Kardiovaskuläres Risiko berechnen. 2023.
• Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Increase of physical activity in essential hypertension - Rapid report; Commission A05-21D. 2010.
• Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Different antihypertensive drugs as first-line therapy in patients with essential hypertension: Final report; Commission A05-09. July 15, 2009.

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.