Blood Pressure

[EngMac]

I heard something that said stroke risk increases with each blood pressure medication prescribed. I found the following on this website: uab.edu/news/research/item/...

"The harder hypertension is to control, the higher the risk for stroke, even if the treatment is successful. Howard says the risk of stroke went up 33 percent with each blood pressure medicine required to treat blood pressure to goal. Compared to people with systolic blood pressure below 120 mm Hg without treatment, hypertensive individuals on three or more blood pressure medications had a stroke risk of 2.5 times higher."

“You’re in as much trouble by the time you are on three medications that achieve excellent control as you are when you have hypertension and it is untreated, which is amazing,” Howard said. “We want to raise the issue that, despite great advances in a pharmaceutical approach, relying solely on this approach is going to come at a dear price of people’s lives.”

Since blood pressure type medications are often part of the regimen for atrial fibrillation, I was wondering if this is part of the reason why people with atrial fibrillation have higher risk of stroke. Is it the atrial fibrillation that is the cause or the medications given to treat it?

Comments please.

[BobD Volunteer]

It is not the medication which is increasing the risk it is the continuing pressure problem. We know that CHADSVASC dictates that you still score for BP even if medicated for a very good reason. So interesting how they keep moving the goal posts down though isn't it. Few years ago my doctor was happy with 145/90 then wanted it down to 130/80 and now would like to see 120/70--75. More and more it seems that high blood pressure and what it is doing to the arteries and plaque therein etc is the trigger for stroke

[Hidden in reply to BobD]

Hi Bob,

Yep, my BP journey is remarkably similar. My doctor in Sydney was happy with the 145/90, then before I returned to Britain he said try and get it down by 10 both for systolic and diastolic. When I got back here my doctor then said that's too high I think we'll put you on anti BP medication ( Ramipril). I was then averaging 136/80 ish - which is what it was when AF hit. Then when I got down here to Cornwall my doctor says try and get it down to around 125/70 ish. To help me he added Felodopine to my party bag.

I've modified my diet to try and help the cause anyway and get regular exercise and I am now around 126/70. I have found that cutting out ADDED commercial table salt and ADDED sugar from my diet has been a big help in keeping my BP low.

John

[ILowe]

Interesting. Thanks for posting. There are several points in this article.

1/ "Untreated high blood pressure, or hypertension, wreaks havoc on the body, leading to heart disease and stroke." But what causes the high blood pressure in the first place? High blood pressure is a symptom that needs investigation, and the underlying cause addressed. But does high blood pressure in itself do damage? Here, we need to look closer at the definition of hypertension. It is well known that drug companies have influenced medical opinion to have a very very low definition. Yes, very high pressures, such as 200+ are getting serious, but not 160 for a 60 year old. The article takes 140 as acceptable maximum.

2/ "The harder hypertension is to control, the higher the risk for stroke, even if the treatment is successful." Surprise surprise. This fits point 1/

3/ I see that the article is still perpetuating the idea that low salt helps. The evidence I have seen points in the other direction. A low salt diet can be dangerous.

4/ A fair conclusion from the new evidence is that only those with severe problems should by taking a blood pressure tablet. The article seems strangely reluctant to draw this conclusion.

5/ For more corroboration, see a new book by James Le Fanu, "Too many pills: how modern medicine is endangering our health and what we should do about it." Here is a quote from chapter 2. "The definitive verdict came in 2012 with a review of the several clinical trials comparing the merits of antihypertensive drugs with no treatment: ‘Compared to placebo, treatment with antihypertensive drugs does not reduce any outcome’, noted Professor Stephen Martin of the University of Massachusetts in an editorial in the British Medical Journal. ‘It reduces neither stroke nor heart disease nor total mortality.’ From this he concludes, ‘It would be less costly [to the tune of $19 billion, the cost of treating mild hypertension in the United States] and yield better outcomes to target efforts in high risk patients rather than low risk individuals with unclear benefits.’

[CDreamer in reply to ILowe]

Interesting - so much confusion - I do think there are more variables than just cause and effect ie:- hypertension = increased stroke risk. Although I can see that 180+ is obviously going to put too much pressure on fragile arteries. And I am very glad to see challenges to constant medicate, medicate, medicate.

My take is that we are all going to die of something at some time - a stroke if it kills - is not a bad way to go rather than fading away very slowly from neurological dysfunctions - but then I may be biased.

[BobD Volunteer in reply to CDreamer]

As you know my wife is a carer and I totally agree with your last comment. On the old Yahoo forum we started with we had a member who commented " when I arrive in my grave I want it to be sideways with a drink in one hand a cigar in the other shouting "what a ride what a ride"". (I missed out the bit a about the blonde. lol )

Of course the big risk is the stroke doesn't kill you.

[ILowe in reply to CDreamer]

There is loads of evidence that Big Pharma has influenced medical opinion, to see lowering blood pressure as very important, and to make it an issue by lowering the numbers for what is acceptable. This has been known for decades. This results in more money spent for drugs, more time wasted by doctors (as Le Fanu well explains), and, crucially, more negative "effects" from drugs. I think wisdom lies in keeping medicines down to a minimum, using them for short term where needed.

[EngMac in reply to ILowe]

To me the article said more drugs for blood pressure increases the stroke risk. Adding drugs to impact it may keep it lower but stroke risk goes up.

So now you have a lower blood pressure but a high stroke risk and with three drugs the same risk as with high blood pressure and no drugs. Did I miss something? If the stroke risk goes up, why are anticoagulants not recommended? The drug companies missed this possibility or they don't want questions asked about drug pressure medication.

Blood pressure can go to 400/200 when you exercise, which is recommended, and the arteries don't blow apart. I think there is a bit of learning still required and the profit incentive may be skewing the desire to learn.

I posted Dr. John Bergman's YouTube video on blood pressure. His suggestions are likely more correct than those of most doctors who probably have not researched this to any great degree. They likely just regurgitate the drug company view.

[JoWilmer]

TOO MANY BP MEDS... after a TIA, carotid surgery and BP receptors in neck damaged by carotid surgery, it was a real issue to control my husbands BP. As high as 235, they would add another med, after a few days, back up.

With 4-5 BP med's lined up and taking daily...BP still not in safe range...anything below 160. So, after being in health field and working with these blindfolded doc's for over 20 years I said "enough is enough."

"You are placing more stress on his kidneys, with all these BP to target different BP sources." Stop them all. Give him Clonidine. This is what we give when someone comes into the MD office with high BP and we want to get it down quick.

Reluctantly our MD did. Well, my hubby takes CLonidine 0.2 three times a day.

(it works on the brain, not kidneys, not a diuretic, not a calcium channel or beta blocker, etc)

No more BP issues. BP stays below 160. By the way, which is fine. Being in his 70's it is fine. As we age, our BP goes up. After all the heart is a muscle and loses its strength as we age, so heart NEEDS to be a bit harder.

Hope this info helps.... Ask your doctor.

[Mrspat]

I have just experienced this issue. The goal posts have been moved downwards several times. I have declined to take medication for my borderline high BP, which would be on top of two AF medications, anticoagulant and thyroid medication (needed because of Amiodarone).

One issue that does confuse me in relation to all of this is hydration/diuretics. My GP said that she would propose a BP medication that isn’t a diuretic.

As a side issue - my 70 year old husband has BP of 120/70 and it is sometimes lower. Doctor suggested that he needs to drink more water, especially in the mornings,to get his BP up a bit!

[pirnough6 in reply to Mrspat]

I experienced similar attitudes to bp. Having suffered for a month with high bp 210/100 they increased my dose of one of the tablets and now my bp is between ,110/60 and 120/70 which the doctors day is very good. Also the doctor at A and E said I shouldn't panic until my blood pressure was over 250/110. I am not sure about that. I thought I should go to A and E if my bp was over 210/110 and it wouldn't go down even after medication

[BobD Volunteer in reply to pirnough6]

When my BP gets as low as 110/60 I have trouble standing up without going dizzy! I can just about function at 120/70.