There was a time when medicine was considered 'at all costs' but the costs were a lot lower. With malpractice attorneys on call and 'defensive medicine' to include every test so that during fact-finding all of the bases are covered, costs have skyrocketed.

But governments that fund health care want to get the most effective treatment for the money. Both the vaguely defined "pre-diabetes" and hypertension drugs for low-risk people are worrying trends. In a new paper, Dr. Stephen Martin and colleagues urge clinicians to be cautious about treating low risk patients with blood pressure lowering drugs.

Up to 40% of adults worldwide have hypertension but over half of those are classified as "mild." Low risk indicates that an individual does not have existing cardiovascular disease, diabetes, or kidney disease. Over the years, hypertension has been treated with drugs at progressively lower blood pressures. The belief has been that drug treatment of even mildly elevated blood pressure levels in low risk patients may reduce cardiovascular risk and therefore future health costs too.

But now current health care costs are overrunning government budgets. Over half of people with mild hypertension are treated with medication, yet treating low risk mildly hypertensive patients with drugs has not been shown to reduce cardiovascular disease or death.

In the US alone, where hypertension is the most common condition for a medical visit, the cost of drug treatment of mild hypertension has been estimated at $32 billion per year. That corresponds to more than 1% of annual health care costs and more than one third of total US expenditures on public health.

The authors argue that overemphasis on drug treatment "risks adverse effects, such as increased risk of falls, and misses opportunities to modify individual lifestyle choices and tackle lifestyle factors at a public health level."

And they urge clinicians to share the uncertainty surrounding drug treatment of mild hypertension with patients, measure blood pressure at home, improve accuracy of clinic measurements, promote public health investment, and "encourage lifestyle changes to treat hypertension, including weight loss, smoking cessation, decreased alcohol consumption and increased exercise."