Almost half of U.S. adults are now classified as having high blood pressure based on the updated definitions. But does this mean everyone with a diagnosis of hypertension needs medications?
A new study published in the Journal of the American Medical Association (JAMA), suggests the blood pressure guidelines go too far for low risk individuals, and the risk of harm outweighs the potential benefits.
The JAMA study was an extensive chart review of over 38,000 patients at low risk for heart disease who had stage two hypertension (blood pressure between 149/90 and 159/99) and were treated with blood pressure medications. Over an average follow-up time of almost six years, they found no reduction in the risk of cardiovascular disease events or risk of death with medication use. They did, however, find an increased risk for low blood pressure, fainting, and acute kidney injury among those treated with medications.
In 2012 meta-analyses of anti-hypertensive drug treatment compared to placebo or no treatment trials up until the end of 2011 found that, antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) at a period of four to five years follow up, no differences were seen in mortality, cardiovascular events, CAD, or stroke. Treatment caused 9% of patients to discontinue treatment due to adverse effects.
Based on these results, treating stage two hypertension in low risk patients tends to cause more harm than good.
According to TheNNT group, none were helped (preventing death, stroke, heart disease, or cardiovascular events) for those who received medication for the treatment of mild hypertension, but 1 in 12 were harmed (medication side effects and stopped the drug). Up to 40% of adults worldwide have hypertension, over half of which is classified as “mild.”
According to a recent randomized trial that enrolled 1,318 Australians from an online panel, ‘Hypertension’ and ‘high-normal’ labels may cause more harm than good in low-risk patients. Advising people that they are hypertensive or high normal when they have low risk of cardiovascular disease potentially may cause harm rather than engage them.
A 2015 study found that people on hypertension drugs can have stroke risk almost 2.5-times greater than those without high blood pressure. Their study involved 26,785 participants 45 and older.
The findings from all these studies are a timely reminder of the Hippocratic oath, ‘First, do no harm’. Since guidelines are evidence-based, they should also consider the increasing evidence of patients’ responses to having a medical label because words do matter to the patients. And this possibility for harm is only amplified if this may lead to initiating treatment with potential side effects.
A new 2021 Canadian study finds that for people who take thiazide diuretics — were associated with higher rates of keratinocyte skin cancers, including basal cell carcinoma, squamous cell carcinoma, advanced keratinocyte carcinoma and melanoma.
Calcium channel blockers reduce pancreatic insulin secretion and induce end-organ insulin resistance causing hyperglycemia.
Experimental models show that CCB toxicity shifts myocardial substrate preference to carbohydrates from free fatty acids; thus cardiac substrate delivery is impaired. Additionally, CCBs interfere with calcium-stimulated mitochondrial action and glucose catabolism; this results in lactate production and ATP hydrolysis contributing to acidosis.
All the above studies indicate, that drugs are not the solution. Actually, most drugs don’t benefit most of the patients who take them. Since we have no way of identifying those who will benefit, we are stuck treating the many to benefit the few. Its like buying a lottery ticket or buying insurance. Say, most of us pay for fire insurance for our homes, but not many houses burn down. We willingly pay premiums that may never benefit us because the cost of an uninsured disaster is so great. Paying premiums has no real harms apart from money spent while drugs inevitably have side effects.
By the way, according to the research paper published in American Heart Association Journal (dated 9 March 2018) the mortality rate drops when the doctors are absent from the ICCU. This means the chances of survival of the heart patient increases because of the absence of doctors, responsible to take care of patient. Its shocking but true.
Researchers at Harvard Medical School found that when heart specialists are away at academic conferences, the survival rate at their hospitals actually improves. They believe that specialists who attend the meetings are more prone to using intensive interventions for their patients which may do more harm than good, rather than taking a more holistic approach.
The most recent update to the AHA hypertension guidelines refined how we classify hypertension. A systolic pressure between 120-129 and a diastolic above 80 is now classified as “elevated blood pressure.” A systolic pressure between 130-139 and diastolic 80-89 is now stage 1 hypertension, and a systolic greater than 140 or diastolic greater than 90 is now stage 2 hypertension.
Since people living with type 2 diabetes are at increased risk of heart disease, guidelines from the AHA and ACC recommend a blood pressure goal of 130/80. However, the ACCORD trial as well as a meta-analysis of randomized trials suggest aggressive treatment to this level does not reduce cardiovascular events but may increase significant adverse events. Thus, the latest recommendations from the American Diabetes Association set the target blood pressure for those with diabetes at 140/90.
The evidence supports that stage 1 hypertension and stage 2 in otherwise healthy individuals are best treated with lifestyle interventions.