A newly issued guideline by the American Heart Association that categorizes adults with Blood Pressure of 130/80 as hypertensive (high blood pressure) compared to the old standard of 140/90, increasing the number of subjects for whom treatment plans should be initiated to 46% of the American adult population. This new guideline will largely pertain to adults in their 40s who have creeping elevated blood pressure.
Adults with 135/85 blood pressure are said to be at double the risk for a stroke or heart attack compared to adults with a blood pressure of 115/75.
Under guidelines issued 14 years ago, only 32% of American adults were considered hypertensive.
Don’t jump to conclusions
Before American adults who take their blood pressure at home and suddenly find their blood pressure numbers exceed the new 130/80 mark and then run to the doctor’s office for prescription pills to control their blood pressure, they need to know about age-adjusted blood pressure.
(For reference, the first blood pressure number is the pumping or systolic pressure and the second number is the resting or diastolic number. Low blood pressure is below 90/60.)
What the newly issued report didn’t say is that age-adjusted risk assessment suggests higher blood pressure numbers can be tolerated without increased risk for death.
Age-adjusted data, reported by researchers at UCLA a few years back show any risk for death from uncontrolled hypertension doesn’t start till blood pressure is 160/90 or more among adults 55 years of age or older.
So if you are adult over age 55, you need not have fear of dying because your blood pressure is over 130/80. The pronouncement a person has high blood pressure may be a self-fulfilling prophecy. These poorly founded fears of dying of a stroke could provoke anxiety sufficient to raise blood pressure in itself.
The numbers in greater detail
While the overall increased risk for strokes is low at so-called normal (136/88) blood pressure, it carries a five-fold increased risk for stroke when compared to a blood pressure of 110/70. A third of the people who die of strokes and heart attacks have blood pressure below 140/90.
That can be explained blood platelets that have a tendency to clump to form blood clots that impair circulation to the heart and brain. So elevated blood pressure is not the sole predominant factor for strokes. But nonetheless, having the blood pressure you had in your teens is desirable throughout life.
This new target number to treat blood pressure translates to 103 million Americans who categorically have high blood pressure, about 46% of the adult population. Under prior guidelines an estimated 72 million or 32% of American adults were considered to be hypertensive (high blood pressure). The latest review of the medical evidence shows adults with 130-139 systolic pressure doubled their risk for a stroke, heart attack, kidney or heart failure compared to those with lower blood pressure.
HealthDay reports an additional 4.2 million Americans will now be considered hypertensive. An Associated Press story said an additional 30 million Americans would now be categorized as having high blood pressure. Only 2% of the people newly added to the hypertensive category will need medication however. These will be high-risk individuals or those who have already experienced a stroke, heart attack or kidney problems. The new guidelines largely pertain to adults in their 40s with a creeping rise in their blood pressure. Or at least that is what experts say. But the new guidelines will likely be used to justify placement of more and more patients on problematic drugs.
Two or more drugs needed
Here is what prior medical advice was for hypertension: “Many people with high blood pressure need two or more blood pressure-lowering drugs to reach the goal of less than 140/90 mm Hg. Because hypertension is a chronic condition, you will most likely need to take your medication indefinitely.”
Apparently the use of multiple low-dose anti-hypertensive drugs works synergistically over the use of a single drug given in high doses. This low-dose combo-drug approach is said to reduce side effects as well.
There are 10 classes of blood pressure drugs—diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers, beta-blockers, alpha-blockers, central alpha agonists, direct vasodilators, peripheral-acting adrenergic antagonists and direct renin inhibitors. Diuretics (water pills) are often the first choice of drug therapy followed by ACE inhibitors, calcium blockers and vaso-dilators. If any one of these drugs worked, the others would not be needed.
Let’s re-word the lame explanations offered by conventional medicine regarding anti-hypertensive drugs. Here is what the Centers for Disease control says:
“More than a third of American adults have high blood pressure (now 46% according to new definitions) and more than half of them have uncontrolled blood pressure even with prescription of multiple drugs.”
Here is what should be said:
While these drugs are proven to be effective in human clinical trials, the average hypertensive patient does not experience the same result as those enrolled in studies. The more pills to swallow the greater the problem of non-compliance by the patient. And, very bluntly, none of these drugs is effective on their own as most all patients have to take multiple drugs to get their numbers under control. And frankly, modern medicine ends up treating blood pressure as if it is a drug deficiency. Unfortunately, American adults will not hear of this from conventional sources of health information.
Relative risk versus absolute risk
In 1986 the British Medical Journal published a guideline paper that asserted “there will be no appreciable benefit to an individual patient from treating a diastolic pressure of less than 100.” While drugs lower blood pressure, they may not reduce the risk for a stroke or heart attack or death. But the medical profession marched forward, recognizing patients are not likely to stop smoking, adhere to a healthy diet and trim excess weight, so doctors commonly skipped these measures and begin treating hypertensive patients as if they were drug deficient.
The effectiveness of anti-hypertensive drugs is established on marginal numbers. A relative risk is cited, such as a report published in the JAMA Internal Medicine journal (2014) that concluded beta blockers (drugs that slow the heart rate) do not significantly reduce all-cause mortality (0.94 risk or -6% mortality reduction) while ACE inhibitors significantly reduced risk of all-cause mortality by 13% (0.87 risk of -13%). But in hard numbers anti-hypertensive drugs:
Prevent 1 death among 125 drug users
(less than 1% effective)
Prevent 1 stroke in 67 drug users
(1.5% benefit; 98.5% ineffective)
Prevent 1 heart attack among 100 drug users
1 in 10 patients are harmed by medication side effects (10%)
These numbers look so weak because modern medicine places millions of patients on drugs when strokes and heart attacks only occur in 1 in thousands of people over a time period like 5 years.
According the statistics provided by the Centers for Disease control, 2.7% of adults will experience a stroke in their lifetime and the number of deaths is 41.7 per 100,000. However, new stroke treatment guidelines would initiate treatment including drugs for 46,000 adults for the remainder of their lifetime when only 2700 would experience a stroke over a period of many years.
Using these numbers, possibly 6% of patients using anti-hypertensive drugs would avoid a stroke or death while 94% would derive no health benefit and experience nothing but side effects.
So millions of people are placed on drugs that would never experience a stroke or heart attack to spare the few who actually are at risk. Since strokes can occur for other reasons than hypertension, such as clumpy blood platelets, it is difficult to realize a health benefit from taking these drugs.
Weigh the side effects
Millions of patients taking anti-hypertensive drugs experience chronic coughs, nausea, dizziness, mental depression, heart failure, fatigue and gastric irritation.
For example, there are an estimated 35-40 million patients worldwide that have been prescribed ACE inhibitors for hypertension. About 5-35% of these subjects or 2-14 million will develop chronic cough. Side effects outweigh the imagined health benefits.
On a worldwide scale, there are an estimated 1 billion hypertensive adults with a malady that is attributed to 7.1 million early deaths a year. In the U.S. some 50 million are under treatment for hypertension. This is in a population where only 1 in 10 consume enough fruits and vegetables.
The percentage of patients whose blood pressure remains under control after withdrawal of drugs ranges from 3% to 74%.
In one study of patients on medication for high blood pressure, 33% took one drug, 35% two drugs and 32% took 3 or more medications. About 35% of patients did not adhere to the prescribed medication regimen.
Treatment resistant hypertension
Patients whose blood pressure is controlled with four or more medications are categorized as having resistant hypertension.
Failure to maintain healthy blood pressure numbers even with drug therapy is common. In one large study, only 67% of participants had their systolic blood pressure lowered below 140 whereas 92% of participants achieved a goal of 90 or less diastolic pressure.
Long term, only 40% of patients continue to take anti-hypertensive drugs.
Strikingly, commonly used over-the-counter anti-inflammatory pain relieving drugs (aspirin, acetaminophen) are the most common pharmacologic agents that worsen blood pressure.
Diabetes complicates hypertension. In order to achieve the lower blood pressure goal recommended for patients with diabetes, an average range of 2.8 to 4.2 antihypertensive medications will be needed.
While it is widely quoted that resistant hypertension accounts for 20-30% of cases of hypertension, a modern review suggests lack of compliance in taking drugs and other factors are more likely to explain the problem.
There is a difference between blood pressure measurements taken in the doctor’s office and at home. A phenomenon known as “white-coat hypertension” (patients sees the doctor’s white coat and blood pressure rises) is identified as the reason for this difference. This is pertinent when determining if patients truly have treatment resistant hypertension. While it is often said 20-30% of hypertensive patients are resistant to drug treatment, the occurrence of treatment resistance is cut in half (~10%) when blood pressure is measured at home.
A study of 140 patients with treatment resistant hypertension is instructive:
- 140 treatment resistant hypertensive patients
- 69 were taking 3 different classes of medications
- 15 of these 69 patients (22%) controlled their blood pressure when blood pressure monitoring was conducted at home
- 20 of these 69 patients (29%) were not taking their medications as prescribed
- 34 of these 69 patients (49%) adhered to medication regimens and had uncontrolled hypertension and were likely taking suboptimal drug dosages
So what are adults with high blood pressure to do? That is the topic of a forthcoming report.
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