Doctors in Kolkata welcome new WHO blood pressure treatment protocol – Times of India

Kolkata News
KOLKATA: The alteration in blood pressure parameters for commencement of treatment, announced by the WHO earlier this week, will force them to be more cautious about prescribing medicines, said doctors.
Since the threshold for introducing drugs has been pulled up from what medics in India now stick to, the decision on prescribing drugs could now be more conservative, said doctors and experts, adding that it will still have to be on a case-to-case basis rather than toe a rigid guideline.
The WHO has set 130 as the upper limit for commencement of medication for those with risk factors or cardiovascular diseases and 140/90 for others. As per the Indian health ministry guideline, pressure readings of 130-139/80-89 were to be advised a check-up after a year and sooner in the case of those with a history of cardiovascular ailments.
The bar had been set higher in India by the health ministry which has now been brought down by the WHO guideline, according to cardiac surgeon Kunal Sarkar. “The bar has been brought down marginally for medication and treatment which is not a huge one. But other than this, medics need to be careful about the medicines they prescribe. There is now a bigger confusion about which drugs to prescribe than about the time of commencement of medication,” said Sarkar.

He added that it is important to formulate first, second and third line drugs for blood pressure patients depending on the readings and co-morbidities. “Many have side-effects that could be harmful for those suffering from cardiac ailments, diabetes or chronic kidney diseases,” he added.
The WHO guideline has also suggested a combination of two drugs instead of one, even if it’s single pill of combined medicines. The suggestion is already followed by most physicians, said RN Tagore International Institute of Cardiac Sciences intensivist Sauren Panja. “It leads to a synergic effect, helping to reduce side-effects of one drug and the drugs usually complement each other,” he said.
But the threshold numbers recommended by WHO are not much different from the Indian guideline, Panja said. “Most medics don’t prescribe medication to healthy individuals till their upper reading touches 140, which has now been recommended. Those between 130 and 139 are prescribed drugs in case they are diabetic, have cardiac or kidney ailments. But there was perhaps a need to reiterate this for blood pressure is dynamic and medicines can have an adverse impact for those who have narrowly crossed the threshold,” Panja said.
He added that there have been cases where individuals with marginally high systolic (upper level) have been prescribed drugs as per Indian guideline, leading to severe bouts of dizziness, nausea or even bouts of senselessness.
Though healthy individuals don’t need medication till 140, they need lifestyle changes, regular exercise and restricted diet to make sure they don’t cross the threshold, said consultant Arindam Biswas.