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Don’t Let Them Drug You for Mild High Blood Pressure

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Americans are in agreement. We’re being overmedicated. Whatever the ailment, there’s a supposed quick-cure pill to save the day. Although we are very fortunate to have access to certain lifesaving drugs, we must resist the pharmaceutical-industry onslaught with its risks and side effects! Latest case in point: Blood pressure control. The latest research shows clearly that many physicians are way too quick to break out their prescription pads when simple lifestyle changes may do the trick to control high blood pressure without the risk of side effects. You might very well be taking unneeded blood pressure medication. Here’s how to know…

ONE SIZE DOESN’T FIT ALL

Of all the people the world over who have high blood pressure, more than 60% have a mild form of it. Although evidence doesn’t show that treating mild high blood pressure with drugs changes the risk of a first heart attack or stroke (except for people with diabetes or chronic kidney disease), most patients with mild high blood pressure are treated with medication anyway. Some health organizations want to change the guidelines, but most are resisting. This got Stephen A. Martin, MD, an assistant professor from the University of Massachusetts Medical School, along with a team of American and Canadian doctors, to argue in a recent article in the medical journal The BMJ that things have got to change.

For one, they point out, guidelines to treat everyone with mild high blood pressure with drugs are not based on evidence but “expert opinion.” Evidence, on the other hand, tells us that deciding who should be treated with drugs is a little more complicated and should depend not on a number on a blood pressure monitor, but on age, sex and specific risk factors such as diabetes or kidney disease.

In other words, one size does not fit all—despite what the drug companies or even some lackadaisical doctors might want!

According to the American Heart Association, you have mild high blood pressure (also called hypertension) once your blood pressure hits 140/90. The first number represents systolic blood pressure—the maximum pressure when your heart muscle is contracting. The second number represents diastolic pressure—the lowest pressure when your heart is relaxed. Before we go further, here’s a quick reference on blood pressure readings:

Desired range: Systolic 90–119 / diastolic 60–79.

Prehypertension: Systolic 120-139 / diastolic 80-89.

Mild hypertension: Systolic 140–159 / diastolic 90–99.

Hypertension: Systolic 160 and higher / diastolic 100 and higher.

The definition of mild hypertension was decided back in 1977 (based on expert opinion, not clinical evidence). Doctors didn’t prescribe drugs for it then, but now they virtually all do, so that 94% of people age 65 and older who have any type of hypertension are on a drug, according to Dr. Martin. But an analysis conducted by a team of researchers and published as a Cochrane Review showed that antihypertensive drugs do not reduce risk of heart attack or stroke any better than placebo in people with mild hypertension. The analysis from The BMJ also noted that studies that show the benefit of antihypertensive drugs in people with severe hypertension are deceptively used to justify use of these drugs in people with milder forms of it.

Why? Follow the money. The estimated cost of treating mild hypertension in the United States is $32.1 billion per year!

A BETTER APPROACH

Dr. Martin and his colleagues pointed out that medicating people with mild hypertension is often an incentive for them (and their doctors) not to make necessary lifestyle changes. Why bother when you can just take a pill? Rather than overdiagnosing hypertension and overprescribing antihypertensive drugs, Dr. Martin says, much more effort needs to be put into encouraging healthy lifestyle changes, while reserving drug treatment for people who really need it—those who are known to be truly at risk for heart disease, such as people with diabetes, chronic kidney disease, metabolic syndrome and blood pressure that is 160/100 or higher.

Besides that, Dr. Martin and his coauthors point out that blood pressure readings by doctors are often inaccurate. Doctors often do not consider, for example, whether a patient has just smoked a cigarette (taken nicotine) or plied him- or herself with caffeine, which can affect blood pressure readings. And then there’s “white-coat syndrome,” in which anxiety over being examined temporarily increases blood pressure exactly at a time when an accurate reading is needed—while at the doctor’s office! Considering that 20% of people with any level of high blood pressure also have white-coat syndrome, there are almost certainly legions of people out there who have been misdiagnosed with mild hypertension and told to take drugs.

WHAT YOU CAN DO

To better ensure that you get an accurate blood pressure reading, do it yourself at home. Yes, home blood pressure monitoring is preferred, according to Dr. Martin, because it removes white-coat syndrome from the picture and also allows a person to take multiple readings instead of just one. Multiple readings give a better sense of what is really happening.

Blood pressure–monitoring devices are widely available. The AHA recommends cuff-style monitors that fit over the upper arm because they are more accurate than wrist and finger monitors. The AHA gives this guidance for blood pressure monitoring…

• Take two. Measure your blood pressure twice per day at the same times each day, such as morning and evening. And each time you measure it, take two or three readings one minute apart. (Some home monitors will automatically perform three readings in a row and average the results—all you have to do is sit patiently for a few minutes.)

• Relax. Don’t drink caffeinated beverages or exercise (or smoke) within the 30 minutes before measuring your blood pressure.

• Keep a log. Accurately document the date and time of each of your blood pressure readings, and keep that log for presentation to your doctor. (Some monitors have built-in memory to store readings or apps to download the reading to a website for later access.)

If you are told by your doctor that you have mild hypertension and should go on medication, question why and whether lifestyle changes would be the better alternative. For insight on those lifestyle changes, see Daily Health News’s Guide to Preventing and Lowering High Blood Pressure—Naturally.

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Source: Stephen A Martin, MD, assistant professor, University of Massachusetts Medical School, Barre, Massachusetts. His article appeared in The BMJ. Date: January 5, 2015 Publication: Bottom Line Health
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