Drug Treatment for Mild High Blood Pressure Is Often a Bad Idea
One of the strongest risks for heart attack and stroke is hypertension, or high blood pressure, which is a measure of how hard the heart is working to pump blood.
The medical establishment has been aggressive in addressing hypertension with prescription drugs. But a new study in BMJ (British Medical Journal) concludes that treating patients with stage 1, or mild, hypertension with drugs has no benefit.
Study results indicated that drug treatment did not reduce total mortality risk, coronary heart disease or stroke.
Blood pressure (BP) is read via two numbers, systolic (top number) and diastolic (bottom number. Systolic reflects the maximum pressure exerted as the heart contracts, and diastolic reflects the heart at rest, or the time elapsed between beats.
BP readings generally are defined by four levels:
- normal (below 120/80);
- prehypertension (120-139/80-89);
- stage 1 hypertension (140-159/90-99);
- stage 2 hypertension (160+/100+).
Sometimes the two values fall into different categories; the correct reading in that case is the high, or riskier, level.
The BMJ study results were drawn from controlled, randomized trials of more than 8,900 patients with stage 1 hypertension. They were treated for four to five years. People with pre-existing cardiovascular disease were excluded.
Drugs prescribed to treat hypertension fall into several categories, including diuretics (Lasix, Bumex, etc.), ACE inhibitors (Vasotek, Prinivil, Mavik, etc.), beta blockers (Lopressor, Levatol, Inderol, etc.) and others.
Side effects of blood pressure drugs can be significant. They vary depending on the class of drug taken, and include:
- irregular or rapid heartbeat;
- erectile dysfunction;
- weakness, fatigue;
- leg cramps;
- intense, sudden foot pain;
- dry cough;
- skin rash;
- loss of sense of taste;
- swollen ankles;
- dry mouth;
- fluid retention;
- joint pain.
One reviewer of the BMJ research said that the analysis should lead to dramatic changes in the way doctors treat mild hypertension; that behavioral changes—exercise, smoking cessation and improved diet—should take precedence over blood pressure pills.
Dr. Julian Tudor Hart responded to the research with particular insight. “Why has it taken more than 30 years to reach this conclusion,” he wrote, “when it was already evident from any careful and critical reading of the trials claimed originally to justify interventions in the diastolic range 90-100 mm Hg? And what should we do now to get practice onto a more rational footing?”
Hart has long believed that controlling blood pressure with what he calls a “whole community,” or less pharmaceutical, approach is possible and effective. But the medical establishment had been steadfast in finding the 90 mm Hg (millimeters of mercury, the silver element visible in the BP gauge) as the threshold for drug intervention.
After a series of symposia on mild hypertension sponsored by the World Health Organization decades ago, Hart refused to support this advice. The WHO organizer, he writes, “appealed to me to do what all other participants had done, and sign the statement, reminding me that three transnational pharmaceutical companies were sponsoring all three symposia and had a right to expect results. I still refused.”
Really, is anyone surprised that Big Pharma is happy when the medical establishment opts for scorched-earth treatment when a drug-free approach might work better?
After a nasty, profane exchange with other medical professionals, Hart relented and signed the statement supporting drug intervention for mild hypertension. “I thought I had reached the limit of what a mere GP could do without becoming hopelessly isolated,” he explains, but, “… I was never convinced that the very small reductions in cardiovascular and cerebrovascular event rates justified the conclusion, except in diabetics.”
Another researcher at the symposium told of the pressure he had felt to find positive results in large scale studies or risk losing funding for future research. That man, Hart, says, “concluded that, realistically, medical scientists might have to accept that some degree of ‘quasi-science’ was inevitable and therefore justifiable, for obtaining necessary state funding. Conclusions must sometimes be bent to our market.”
Science, Hart admonishes, “cannot include a market for medication accepting all the plausible mythologies lobbyists can maintain among the lay public, media editors and politicians.” The body of knowledge is advanced not only “by showing that new methods are useful, but equally by showing that they are no better than old methods, or perhaps don't work at all. All three outcomes represent worthwhile gains in knowledge.”
Although not all causes of high blood pressure are known, several factors contribute, many of which individuals can address without drugs:
- being overweight or obese;
- lack of physical activity;
- too much salt in the diet;
- excessive alcohol consumption;
- advancing age;
- family history of high blood pressure;
- chronic kidney disease;
- adrenal and thyroid disorders.
If your hypertension is mild, and you do not have other, complicating disorders (diabetes, kidney disease, etc.), do not accept a prescription for blood-pressure medicine without discussing lifestyle changes first. If your doctor is unwilling to have this conversation, or to see beyond the pill fix, it’s time for a second opinion.
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