do you really have hypertension #1 - bill sardi
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Preface: Blood pressure is the amountof mercury (Hg) displaced in a column,measured in millimeters. There aretwo numbers for blood pressure. Thefirst number (systolic) measuresthe pressure when the heart pumps,
and the second number (diastolic)measures the pressure when the heartis momentarily at rest. Treatment forhypertension may begin if your bloodpressure rises above 140/90. Forsimplicity, this report refers to bloodpressure in “points” and refers tothe “first” and “second” numbers soreaders do not get confused.
Introduction
pressure. It’s meant to ave t e oppos te e ect.
Americans are living longer and that means 9 out of
0 will face the diagnosis of hypertension during their
et me. J Amer can Me ca Assn 287: 1002-1010,
2002 Every Amer can am y s e y to ave a ove
one treate or g oo pressure, or e agnose
with hypertension themselves. At least this is what
we are to y ea t aut or t es. But o m ons o
Amer cans rea y ave ypertens on? Do t ey nee
e- ong me cat ons? Do oo -pressure ower ng
medications really prevent strokes and heart attacks? .
W en you go to t e octor you see t e nee e ounce
on t e oo pressure a an you can see t at your
pressure s g . But was your oo pressure ta en
properly? A slight shift in your arm position could
pro uce a se rea ngs an you m g t e nee ess y
p ace on me cat on.
ou may e surpr se to n t at t e aggregate
care of hypertension provided by physicians and
p armaceut ca compan es s n a s oc ng state osarray. Ant - ypertens ve rugs on’t wor an may
ncrease t e r s o su en eat . Pat ents t emse ves
are not compliant with dietary recommendations and
are ust a y even ess comp ant w t onerous rug
reg mens. A ter a care u rev ew o t e sc ent c
terature t can on y e conc u e t at t e mo ern care
o ypertens on s tse a azar to your ea t .
T ere s an urgent nee or s mp er, ess pro emat c
ess cost y tec no og es to contro ypertens on. Some
prom s ng s mp e tec no og es ex st, ut are e ngoverlooked by modern medicine.
Here are the details:
Arm position
mproper arm pos t on w en measur ng oo
pressure w t a cu s o ten e y to over- agnose
ypertens on an cause
nappropriate treatment.
T e arm s ou e e
or zonta y, an at
e e g t o t e eart,
during blood pressure
easurement. Failure to perform blood pressure
easurements n t e proper arm pos t on can cause
a pressure o 155 85 to ncrease y 25 11, or rea as
Part I:DO YOU REALLY HAVE HYPERTENSION
AND DO YOU NEED MEDICATION?
By Bill Sardi
“Measure of blood
pressure is probablythe most frequentlyperformed medical act,and the least reliable.”
[Rev Med Liege 57: 250-52, 2002]
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80 96. Accor ng to one stu y, ess t an 8 percent o
nurses an octors measure oo pressure ut z ng t e
proper arm pos t on.
“A relatively small downward arm movement in a pa-
tient’s with high normal blood pressure could inuence
the diagnosis and treatment of hypertension.” Errors
in blood pressure measurement are so widespread
that this casts doubt upon estimates of the preva-lence of hypertension in the population at large and
uncertainty regarding the effectiveness of many
medicines used to treat hypertension. [Internal
Medicine Journal 34: 290-91, 2004]
In anot er stu y, oo pressure was measure n
t e proper or zonta pos t on an t en t e arm was
roppe to t e s e an anot er measure was o ta ne .
For adults with normal blood pressure, their numbers
rose y 8 7. Among ypertens ve pat ents t e num errose y 23 10. J Human Hypertens on 17: 389-95,
2003 Anot er stu y s owe t at t e erence n
arm position results in a 11/12 point difference among
hypertensive patients. [Br Med J 288: 1574-75, 1984]
W enever oo pressure s measure t e arm pos t on
s ou e ocumente . J C n Hypertens on 3: 624-
30, 1987
Proper arm position for measurement
of blood pressure
There are many other reasons why blood pressure
measurement may e naccurate.
• Doctors an nurses may e us ng t e wrong s ze oo
pressure cuff on your arm, which would raise the blood
pressure rea ng. T e s ze o t e cu nee s to matc
your arm s ze.
• One o t e pro ems w t oo pressure measurement
n t e octor’s o ce s t at pressure may e c arte
ur ng a s c v s t. B oo pressure may e e evate
w en you are . A “we visit” to t e octor’s o ce
ay give you a more accurate reading.
• Anot er screte actor may art c a y ra se your
oo pressure. Doctors o ten ut ze a r g t- g t
ophthalmoscope to examine the back of the eyes duringa p ys ca exam nat on. Br g t g t as een s own
o ra se oo pressure n norma y ea t a u ts
Arc ves Env ronmenta Hea t 42: 37-43, 1987
• Another problem in monitoring blood pressure is
at n an attempt to remove mercury- e oo
pressure gauges rom osp ta s an octor’s o ces
or env ronmenta reasons, news ev ces are not as
accurate. Accurate blood pressure measurement may
not e poss e us ng non-mercury nstruments. Newor T mes June 16, 2002
or all of these reasons, some authorities believe
one third to one half of the blood pressure readings
per orme n c n cs an octor’s o ces are wrong
New Yor T mes August 1, 2000
White coat hypertension
any pat ents exper ence anx ety n a octor’s o ce
t’s enoug to ra se oo pressure. Just t e s g t o t edoctor’s white coat can trigger a rise in blood pressure
This has been termed “white coat” hypertension.
n one stu y 20 percent o ma es an 54 percent o
ema es a a “w ite coat” response w en t e r oo
pressure was measured.
Cana an Me ca Assn
ourna 161: 265-69, 1999
any patients diagnosed with
drug resistant hypertension
rea y ave w te coat
ypertens on. T e r oo pressure s e evate n t e
octor’s o ce or c n c, over-r ng t e pressure contro
of medication. When a doctor records blood pressure
one stu y s owe t s ra se oo pressure y 16 to
6 po nts an w en a nurse too t e oo pressure t
ra se t e num ers y 9 to 17 po nts systo c pressure)
Patients see thedoctor’s white coat,
and their bloodpressure rises
above norma[Blood Pressure Monitoring 7293-300, 2002
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Reuters Hea t Dec. 21, 2001; Amer can Journa
Hypertens on 14: 1263-69, 2001
Researc ers est mate t at 25 percent o ypertens ve
patients can postpone drug treatment and 15 percent
can avo mu t p e- rug t erapy y mon tor ng t e r
oo pressure away rom octors an nurses. J Am
Me ca Assn 278: 1065-72, 1997; 279: 197-98, 1998
Home oo pressure mon tor ng appears to e a etter
a ternat ve, away rom t e stress- n uc ng r se n
oo pressure at t e
doctor’s ofce (white
coat hypertension).
A recent stu y o
ome oo pressure
mon tor ng revea s
more of these patients
are e y to a an ont e r me cat ons
25.6%) t an pat ents
being monitored at the
doctor’s ofce (11.3%) and that their blood pressure
was more e y to e out o contro . Fe ruary 291:
955-64, 2004
OES HOME BLOOD PRESSUREMONITORING IMPROVE COMPLIANCE?
Survey o 1452 patientsHypertens on Researc 23: 21-24, 2000
Frequency o use o omemonitoring o oo pressure
Occasiona ymisse ta ing
their medications
very day 6.5%
Severa times a wee .
Severa times a mont 11.0%
ever c ec e t eir oopressure
14.5%
Millions are/aren’t hypertensive
More t an 16 on o ant ypertens ve rugs were
sold in 2000. More than half of the patients on these
me cat ons ave or er ne or m ypertens on. I
sma ec nes n oo pressure cou e ac eve ,
ons o peop e may not even nee t ese
e cat ons.
A out 50 m on Amer cans ave g oo pressure
and about half are being treated. Only about 27 million
ave t e r oo pressure un er contro .
Accor ng to t e preva ng cr ter a, one t r o
American adults are hypertensive and don’t know itReuters Hea t May 19, 2000 While 140/90 is the
ong-standing point where treatment is started
ow investigators say the desired point for blood
ressure is now 115/75. The once-healthy 120/80 is
now considered to be “ pre-hypertension. ” That means
anot er 45 m on Amer cans are n or a surpr se on
e r next octor’s v s t. T e Lancet Dec.14, 2002
ut do you really have high blood pressure? Are you
really at an increased risk for stroke or a heart attack?
Accor ng to a s oc ng stu y con ucte y Un vers ty
o Ca orn a at Los Ange es researc ers, illions of
eople are taking blood pressure-lowering drugs
or no good reason. Flawed statistics have been
use to eca es to prescr e t ese rugs. P ys c ans
now cons er t e rst oo pressure num er systo c
pressure) as t e mportant n cator o a uture mortaevent like a stroke or heart attack. Usually pressure-
owering drugs are prescribed when the rst pressure
num er r ses a ove 140, ut rev se gures w c ta e
age nto cons erat on n cate an ncrease r s o
y ng oes not start t pressure reac es 148 or ma es
and 158 for females age 55-64 years. For adults age 65
74, t e gures r se to 159 or ma es an 167 or ema es
Lancet 355: 175-80, 2000 T s re-ana ys s o oo
pressure r s s as een suppresse . Hea t aut or t es
are in denial that their long-standing numbers used to
determine when treatment should be prescribed areat y wrong.
he diastolic blood pressure (second number)
hich has been the main criterion used by most
hysicians to determine effective drug control
of hypertension, appears to be of little value in
redicting future adverse health events such as
At least a third ofpatients who exhibita high blood pressurereading in the doctor’sofce do not exhibit thesame problem whentheir blood pressure is
taken by a nurse.[Am J Hypertension 14: 1263-69,2001; BMC Cardiovascular Disorders4: 2, 2004]
120/80 used to be considerednormal blood pressure.
Now it is considered pre-hypertension.
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stroke or heart attack. The systolic blood pressure
rst num er) s a goo pre ctor o t ese events.
Arc ves Interna Me c ne 162: 577-81, 2002 T e
Nat ona Heart, Lung an B oo Inst tute now says t e
rst blood pressure number is more important than the
secon an t at t s ou e ept e ow 140, regar ess
o age. CNN May 4, 2000 For decades physicians
had been gauging the severity of blood pressure byt e wrong num er.
Does drug therapy work?
The quoted gures are that drug therapy may reduce
mortality rates by 12 percent, coronary heart disease
by 20 percent and stroke by 36 percent. [Biomed &
harmacotherapy 51: 208-12, 1997] The problem is
at t ese are elative, not hard numbers.
Statistics tell doctors whether blood pressure therapy
orks, but it doesn’t tell them who will benet.
esearc s ows t at to prevent 1 eat , 11 pat ents
w t ypertens on ave to ower t e r oo pressure
y a out 12 po nts over a 10-year per o . Drug Top csan. 26, 2004 In ot er wor s, 10 o 11 pat ents ta ng
anti-hypertensive drugs will not experience a health
ene t. T e ant - ypertens ve rugs are proven to e
ore e ect ve t an not n arge popu at ons, ut many
ons ta e t ese rugs w t no ea t ene t so a ew
will be spared of a mortal health event.
edical treatment of hypertension may reduce
strokes but have no effect upon lowering the rate of
eart attac s. J Hypertens on 18: S3-7, 2000
n France, a study showed that drug therapy did not
control elevated blood pressure among 85 percent of
714 men. Arc ves Interna Me c ne 162: 577-81
002
Ot er stu es s ow as tt e as 6 n 100 ypertens ve
pat ents are a e to contro t e r oo pressure to
below the target number of 140/90. [J Hypertension
6: 747-52, 1998
A study in Germany found that on an average
day over 700,000 patients are seen by physicians
ith high blood pressure and only 132,000 of these
atients have well-controlled pressure. Better t an 8
out o 10 o t ese pat ents were ta ng oo pressure
e cat ons. J Hypertens on 22: 479-86, 2004
REVISED TOP BLOOD PRESSURE NUMBER WHICH
INDICATES NEED FOR TREATMENT
ge - ge 55-64 Age 65-7
Top oo pressurenumber that
in icates increase
ris o ying anneed for medication
a es 141
Fema es 142
Ma es 148
ema es 158
Ma es 159
ema es 167
Source: Los Ange es Times January 14, 2000
ARE YOUNG ADULTS REALLY ATRISK FOR HYPERTENSION?
High blood pressure may often be misdiagnosed
in young adults. In a stu y o more t an 13,000
n v ua s w ose oo pressure a een measure
annua y or t ree years, o 36 men age 16 to 34 to
who had been classied as needing treatment, only
1 rea y nee e treatment. On y 5 o 19 womenactua y nee e treatment. BBC News Apr
5, 2004; Br t s Me ca Journa , Apr , 2004
The numbers used to determine the point when
treatment should be prescribed may not apply to
young a u ts. The absolute risk of experiencing a
major cardiovascular event over a 10-year period
amounts to only 1% for hypertensive young
adults, age 25-34 years. But this gure is said to rise
to 30 percent among o er a u ts, age 65-74 years.
B ome & P armacot erapy 51: 208-12, 1997
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S ng e ant - ypertens ve rugs genera y are not
e ect ve. Most o t e t me more t an one rug s
requ re to r ng pressure un er contro .
rug: 50-60% un er contro
2 drugs 80% under control
3 rugs: etter t an =80% un er contro
Two or t ree ant - ypertens ve me cat ons are y no
means t e en o t e rug st prescr e y p ys c ans.
Low-dose aspirin therapy to prevent blood clots andstat n rugs or c o estero are o ten prescr e n
a t on to t e pressure- ower ng rugs. An ant -
a et c me cat on may a so e nee e or n v ua s
with blood sugar issues. [J Human Hypertension 18:
39-85, 2004] Now you have polypharmacy – a patient
e ng overw e me y too many me cat ons an
ac ng rugs t at on’t wor we w t eac ot er, an
t at n uce nutr ent e c enc es as we . Var ous reports
admit to the problem of juggling so many drugs while
st attempt ng to avo s e e ects. Car ovascu arDrugs & T erapy 12: 186-98, 1998
A recent study attempted to determine if simpler
dosage regimens, such as one pill a day, would increase
a erence to treatment. Re uct on n t e num er
o a y oses appears to ncrease comp ance n
some stu es. Coc rane Data ase System Rev ew
CD004804: 2004
Desp te t e act t ere are our ma or c asses o oo
pressure lowering drugs and over 100 varieties of these
drugs available, less than 50% of patients who begin
treatment continue taking any of these drugs sixmonths after initial use. Cana an J Car o ogy 15:
39-41F, 1999
Side effects with drug therapy
Far more side effects occur from anti-hypertensive
medications than are reported. Sometimes it is
difcult for patients to connect a side effect with a
drug. In one study conducted in Norway with 2,586
pat ents ta ng oo pressure- ower ng rugs, t e
spontaneous reporte s e e ects were on y 16%. But
upon genera nqu ry 24% reporte s e e ects an
when specic questions regarding common side effects
were as e 62% reporte rug- n uce symptoms
B oo Pressure 8: 94-101, 1999
A survey published in 1999 revealed that about 3 in
0 patients taking blood pressure medications report
s e e ects t at a tere t e r ves. T e most common
s e e ects are at gue, potass um oss an zz ness
Near y 4 o every 10 pat ents a cons ere en ng
heir medication treatments due to adverse side effects
T e survey part c pants were ta ng 3 ant - ypertens ve
rugs, on average. Me ca Tr une, Novem er 12
999
MOST COMMON SIDE EFFECTS OF BLOODPRESSURE DRUGS
Source: Doctor s Gu e Nov. 10, 1999
eta oc ers Fatigue 34%
iuretics water pi s Minera im a ance 30%
Ca cium c anneblockers
Swe ing e ema 26%
CE in i itors Coug 21%
Alpha blockers Cramping 7%
e p ys c ans an p armaceut ca compan es
cont nue to c a m t e raw ac s o t e r rugs are ar
outweighed by their benets, the Agency for Health
Care Po cy an Researc states t at t e potent a
ene ts o these drugs “may not outweigh their
egative effects on quality of life.” Stomac ac es
fatigue, nausea, impotence, headaches, urinary tract
problems, and many other side effects are common. [J
C n ca Ep em o ogy 49:1239-45, 1996; Agency or
ea t Care Po cy Researc report No. 201, 1997
Anti-hypertensive drugs are intended to reduce the
r s or car ovascu ar sease, ut ACE n tors, a
common type o rug use to contro oo pressure
ay ra se omocyste ne eve s y as muc as 16
percent. [Metabolism 52: 261-63, 2003] Homocysteine
s an undesirable blood protein linked with blood vessel
sease. The reduced risk for cardiovascular disease
People who take acetaminophen (Tylenol) or
ibuprofen (Motrin) may double their risk for
hypertension. These drugs may raise blood
pressure by blocking the production of hor-
mone-like substances that widen blood vessels
and can also increase sodium retention.[Curhan G, Archives Internal Medicine, October 2002;
New York Times Oct. 28, 2002]
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via blood pressure control is offset by elevated
homocysteine which raises the risk of hypertension
and cardiovascular disease.
It’s no won er ma es o not ta e a ng to ant -
hypertensive drugs. One study shows that 4 out of 10
ma es n o t e onset o t e r use o oo pressure
ower ng rugs w t mpotence. Am J Hypertens on
2: 271-75, 1999
There is also such a thing as too low blood pressure.
When the second number (diastolic) goes below 65
there is actually an increased risk of stroke, the very
adverse health event drugs are intended to prevent.
[Hypertension 34: 1179-85, 1999] Some hypertensive
pat ents exper ence an a norma y ow oo pressure
ur ng s eep an awa en to n t e v s on n one eye s
gone ecause o a ac o oxygen supp y.
For a long time physicians prescribed calcium
blockers for hypertension without knowing the
drug increased the risk of a heart attack. In 1995
t e p armaceut ca compan es a to per orm a U-turn
and convert patients to slower-acting calcium channel
oc ers a ter t was oun t at t e ast-act ng vers ons
o t s rug actua y ncrease t e r s o eart attac s
y 60 percent. S x m on Amer cans were ta ng t ese
calcium blockers at the time. [Associated Press, March
1, 1995] How many patients died prematurely before
t ese rugs were remove rom use s un nown.
Beta oc ers are anot er c ass o ant ypertens ve
drugs. Since beta blockers increase insulin
resistance, they have been shown to increase the risk
of diabetes. New Eng an J Me 342: 905-12, 2000
D a etes t en astens t e onset o ypertens on. It’s a
self-perpetuating disease.
Lifestyle and health habits
P ys c ans appear to g ve p serv ce to etary an
lifestyle measures to control blood pressure. Here
s w at a report n one ourna sa : “Non- rug
t erapeutic options s ou e imp emente in a
patients. However, since t ere is overw e ming evi ence
to suggest that antihypertensive drugs offer protection
against comp ications o ypertension, a vast majority
wi require p armaco ogica treatment to ac ieve goa
lood pressure levels.” Am J Car ovascu ar Drugs 2
77-89, 2002 In ot er wor s, t e rugs wor , so w y
ot er w t etary approac es to ypertens on?
The British Antihypertensive Society says advice on
e-sty e mo cat ons s ou e prov e peop e
w t g oo pressure. But t e r gu e nes a so
state t at every pat ent
with a sustained systolicoo pressure a ove
60 s ou e starte on
rug t erapy outr g t.
urthermore, diabetics
with hypertension are at
ncrease r s s ou e
starte on me cat ons
e r susta ne oo pressure excee s 140 90. Among
people whose systolic blood pressure is 140-159 and
asto c pressure 90-99, p ys c ans s ou ma e anassessment o car ovascu ar sease r s , say Br t s
gu e nes. A sease r s greater t an 20 percent over
a 10-year period is considered reason to prescribe
edications. The British guidelines concede that
ost pat ents w requ re at east two oo -pressure
ower ng rugs. It’s easy to see ow et an esty e
c anges get pus e as e or t e rugs.
ut can the drugs overcome a poor diet? Inside
he “stroke belt,” the southeastern U.S., anti-
ypertensive drugs are far less effective thann other parts of the country. [Archives Interna
edicine 160: 825-31, 2000] Surveys reveal people
v ng n t e sout ern stro e e t consume t e most
sa t an ower amounts o potass um, magnes um an
ot er nutr ents. Journa Nutr t on 133: 211-14, 2003
The lesson here is that drugs can’t always overcome
e e eter ous e ects o a poor et. But octors eep
prescr ng t e rugs.
lderly patients tend to have more fatty tissue and
his dulls the effect of fat-soluble drugs such as the
eta blockers. This is an admission the beta blockers
are far less effective against a primary group that is at
risk for stroke and hypertension, the obese.
T ere s strong ev ence t at a num er o sma
a terat ons n et an esty e can prevent ypertens on
or ower ex st ng g pressure. Researc ers at t e
How do drugsovercomehypertension in
a patient whocontinually consumes
excessive sugar,salt and alcohol and
smokes?
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Nat ona Car ovascu ar Centre n Osa a, Japan, us ng
ome oo pressure mon tor ng, report t e o ow ng
factors reduce blood pressure:
Accor ng to pu c ea t aut or t es, a re uct on as
sma as 2 po nts n t e average Amer can’s rst oo
pressure num er cou save more t an 70,000 ves a
year.
Hea t pract ce ressure re uct onmm mercury
Top pressure num ersysto c ottom pressure
num er asto c
Weig t re uction
Low ca orie iet 10
Dai y wa ing 2-3 1-2
ow-sa t iet 9 4
otassium
supp ementation
3-4/1-2
Ca ciumsupp ementation
1-2 1
co o restriction 3 2
B oo Pressure Mon tor ng 7: 51-54, 2002
Poor patient compliance is often blamed for the
failure to successfully treat high blood pressure in
the population as a whole. It can be said that it may
be difcult to change simple dietary habits among
hypertensive patients. But half of the patients on
drug therapy abandon their medications as well. Asmuc as 16 to 50 percent o pat ents stop ta ng t e r
oo pressure rugs w t n t e rst year o treatment.
S nce oo pressure s a s ent er, an t e rugs
often cause fatigue, dizziness and other side effects,
t e pat ents o ten ee etter w en not ta ng t e rugs.
Drug Top cs Jan. 26, 2004 P ys c ans conce e rugs
nee to e more amena e to t e pat ents so t ey won’t
stop ta ng t em ue to s e e ects.
Blood pressure lowering drugs
T e rst e ect ve oo pressure ower ng rug ecame
ava a e n t e 1950s. T ere are our ma or c asses o
anti-hypertensive drugs.
THE FOUR CLASSES OFANTI-HYPERTENSIVE PILLS
uret cs ove water an sa t outo t e o y
Beta blockers Slow the heart rate and thusre uce oo pressure
ACE in i itors e uces t e pro uction oa chemical (angiotensin II)t at narrows t e arteries
Ca cium c anneoc ers
lock the inux of calciuminto ce s; re uces orce o
contraction in eart musc e
very anti-hypertensive drug depletes the body of
nutrients. Because of this, there is no way hypertensive
pat ents w ever get we . T ey w su er nutr ent-
re ate s e e ects rom t e var ous rugs see c art on
o ow ng page).
Which pill should be used first?
he conicting reports
octors are involved in a
ong-stan ng e ate on
w c rug to use rst to
reat ypertens on. See
you can make sense of these conicting reports:
WHY YOU WILL NEVER GET WELL TAKINGBLOOD PRESSURE DRUGS
Source: Drug Sa ety: 14: 355-64, 1996
Increasesinsu in
esistance
Raises totac o estero
Raises LDLc o estero
Raisestrig yceri es
Diuretics X X X X
eta oc ers X X X X
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DRUG CLASS GENERIC BRAND NAME NUTRIENT DEPLETED
Ca cium oc er Ateno o Tenormin Coenzyme Q10
Beta oc er Di tiazem Car izem None reporte
Lowers me atonin, a rainormone t at in uces
sleep; drug may cause sleepistur ance Eur J C in P arm
55: 111-15, 1999
Beta oc ers raise c o estero ;c romium supp ements s ou
e ta en to counter t ispro em Ann Interna Me
115: 917-24, 1991
p to 25% of beta blockerusers wi eve op a nee or
anti epressants
ACE in i itor Captopri Capoten ,Benazepri LotensinEna apri Vasotec ,
Lisinopril (Prinivil) QuiniprilAccupri
nc
iuretic Hy roc orot iazi e Coenzyme Q10, magnesium ,osp orus, so ium, zinc, o ic
aci
VasodilatorHydralazineApreso ine
Coenzyme Q10, magnesium,potassium, vitamin B6, zinc,
COMPANION DRUGS OFTEN PRESCRIBED TO HYPERTENSIVE PATIENTS
Acetysa ici ic aci sp r n o ic aci , potassium, so ium,vitamin C, iron
nti-diabetic Glyburide (Micronase
et ormin G ucop age
Coenzyme Q10
o ic aci , vitamin B12
* Magnesium shortage mayresu t in su en- eat eart
attac
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• “ACE inhibitors should be preferred to diuretics in
e er y patients.” Expert Op n on P armacot erapy
4: 825-88, 2003
• Diuretics are considered the rst line of treatment for
e evate oo pressure. Expert Rev ew Car ovascu ar
T erapy 1: 35-41, 2003 “An o as ione iuretic is
as goo , i not etter, t an some newer more expensive
medicines for treating high blood pressure, accordingto a government sponsored study.” Assoc ate Press,
Dec. 17, 2002; J Am Me Assn 288: Dec. 18, 2002
• “The lack of benet and potential side effects of
beta blockers are overstated. Some investigators
recommen t ese agents not e use in t e management
o ypertension in t e e er y. T ere are numerous
reasons w y t ese recommen ations s ou not e
followed. There is abundant evidence that beta blockers
are e ective t erapy.” J C n ca Hypertens on 10 082002
Most hypertensive patients are placed on more
than one medication but unless the drug regimen
includes a diuretic, patients will be at increased risk
for stroke. Arc ves Interna Me c ne 161: 37-43,
2001
At one time the Joint National Committee on
Detection, Evaluation and Treatment of High Blood
Pressure erroneously recommenced beta blockers as
rst-line treatment in the elderly, but beta blockersare inappropriate “and should no longer be used as
initial antihypertensive therapy.” This means that
more t an 7 m on e er y pat ents w t g oo
pressure are expose to t e cost, nconven ence an
s e e ects o eta oc ers w t out any potent a
for health benets whatsoever. [Archives Internal
Me c ne, Ju y 26, 1999
Despite the myriad of side effects, lack of patient
acceptance and ineffectiveness of the drugs, Dr.
Donald Lloyd-Jones at Northwestern University
says elderly patients with high blood pressure need
to be treated more aggressively, with ore rugs.
T e ma or ty o pat ents are e ng treate w t ust one
drug, he claims. [American Society Hypertension 19th
Annua Meet ng, New Yor , May, 2004 Dr. L oy -
Jones says t ey nee more me cat ons.
So which drug is the drug physicians should prescribe
rst? Beta blockers or diuretics? Both of these drugsncrease t e r s o su en eat .
Going off drugs cold turkey
Can ypertens ve pat ents go o t e r rugs co
ur ey? In a Br t s stu y, 22 percent o pat ents w o
stoppe ta ng t e r rugs ne t er su ere a re apse or
related problems after three years. One in three men
and one in six women succeeded at stopping their
e cat on. Br t s Journa Genera Pract ce 49: 977-
0, 1999, BBC News, January 31, 2000
Does weight influencehigh blood pressure?
The literature regarding weight and blood pressure
is conicting.
A study of overweight individuals over a period of 8
years did not show that weight reduction lowers el-evated blood pressure. [Hypertension 36: 20, 2000]
However, another study showed that exercise drops
blood pressure by 2 to 3.5 points, and exercise plus
weight reduction drops blood pressure by about 6 to
8 points. [Hypertension, August 2000]
Another report claims an overweight person may
reduce pressure by about 1 point for every 2 pounds
of weight loss. [Hypertension 42: 878-84, 2003]
Oddly enough, overweight individuals with high
blood pressure are less likely to die prematurely
or have heart attacks or strokes than thinner
people. Fat dulls the heart muscle excitability from
adrenal stress hormones like adrenaline. In thin
people these stress hormones can increase the size
of the heart and cause stiff arteries. [J Am Medical
Assn 285: February 28, 2001]
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The root causes of hypertension
There are four main root causes of hypertension
t at never seem to e proper y a resse . T ese are
ca c cat on, sugar, sa t an n tr c ox e.
Calcification
W en arter es ecome st an n ex e ue to
ca c cat on, ypertens on may eve op. Hypertens on
Research 27: 47-52, 2004] Women develop
ypertens on at an a arm ng rate a ter menopause. T e
re ease o ca c um rom ones n t e post-menopau sa
per o t en accumu ates n arter es w c can resu t
n ypertens on. B o Trace E ement Researc 63:
05-11, 1998] Calcication of arteries in the breast of
ema es, v s e n mammograms, s a so a mar er or
ypertens on. It s nterest ng to note t at arter es n
t e reast on’t eg n to ca c y n women unt age 40and rises with advancing age. [Clinical Radiology 59:
92-95, 2004 But anot er stu y n cates age or gen er
o not n uence ca c cat on. Ra o ogy 224: 235-42,
2002
In one study, coronary artery calcication was found
among 62% o men w t norma oo pressure an
4% o men w t g oo pressure. Coronary artery
ca c cat on s more o ten assoc ate w t ypertens on
in women than men. This is likely due to the loss
o ca c um rom ones n post-menopause, w t t eca c um e ng epos te n arter es. In t e same stu y
c te a ove, 23% o women w t coronary artery
ca c cat on a norma oo pressure w e 62% o
the hypertensive women had calcied coronary arteries.
Me Sc Mon tor ng 2002; 8: CR775-81, 2002
Ca c um- oc ng rugs stop t e n ux o ca c um nto
cells, but they don’t stop arterial calcications per se.
Hormones suc as estrogen, w c sen s a s gna or
ones to reta n rat er t an re ease t e r ca c um, an
v tam n K an magnes um e p to retar ca c cat ons.
Nitric oxide
N tr c ox e s a trans ent gas t at w ens ates)
arter es an contro s oo pressure. It s pro uce
from the amino acid arginine. At low concentrations
n tr c ox e can mprove c rcu at on, ut at g
concentrat ons t can cause c rcu atory s oc an
n uce ce eat .
A recent report n cates t e ec ne n pro uct on o
nitric oxide is a major cause of high blood pressure
oo pressure ower ng rugs ave on y s own m te
a ty to restore n tr c ox e. Current P armaco og ca
es 10: 1695-98, 2004
ecause n tr c ox e s t e agent t at ates oo
esse s an mproves c rcu at on as we as oo
pressure, t e ast o n tr c ox e s assoc ate w t
erectile dysfunction in males. About 4 in 10 males with
erectile dysfunction also have high blood pressure
Journa Uro ogy 171: 2341-45, 2004
n a a oratory researc ers emonstrate t a
agnesium enhances the production of nitric oxide
n t e ce s t at ne t e ns e o arter es. T usagnes um p ays a ro e n w en ng oo vesse s
prevent ng ypertens on an oo c ots. B oc m
iophys Acta 1689: 6-12, 2004]
strogen s e eve to p ay a ro e n contro ng
ypertens on. In an ma s w ose ovar es ave een
remove , supp ementa estrogen as een s own to
ncrease blood serum levels of nitric oxide. [Clin Chim
Acta 344: 53-57, 2004
T e prov s on o p ytoestrogens p ant estrogens) maycounter this problem. In an animal study, female mice
whose ovaries had been surgically removed to stop
pro uct on o estrogen, a g so um et ra se t e r
arter a pressure ut a norma so um et not. T s
eans t e oss o estrogen may ma e ema es more sa t
sensitive. The provision of plant estrogens to these
an ma s on a g so um et re uce t e r arter a
pressure. Am J P ys o Regu Integr Comp P ys o
81: R1934-39, 2001 An exce ent source o p ant
estrogens are lignans found in axseed meal.
Natura mo ecu es ca e po yp eno s, oun n grapes
err es, tea eaves an w ne can n uce n tr c ox e
ormat on. C n C m Acta 344: 53-57, 2004
e w ne mo ecu es ave een s own to en ance t e
oo -pressure ower ng e ects o ot acetyc o ne
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m n s e sense o taste or sa t. N ger Postgra uate
Me ca Journa 10: 96-98, 2003 T ey can eat ots o
sa t w t out sens ng t ey are consum ng too muc .
More than half of the patients with diagnosed
ypertens on are sa t sens t ve. Sa t sens t ve means
a g ven amount o so um n t e et may ra se oo
pressure, ut not among a n v ua s, on y t e sa t-
sensitive.
A stu y n France est mates 5 to 16 percent o ea t y
a u ts ex t a “sa t epen ent oo pressure.”
[Journal Hypertension 21: 289-94, 2003]
O er a u ts can re uce t e r nee or me cat ons to
contro oo pressure y 30 percent y e t er os ng
poun s or re uc ng sa t consumpt on y a out 920
milligrams per day. [Hospital Medicine, October
998
One stu y est mates sa t re uct on wou re uce stro e
deaths by 14 percent and mortal heart attacks by 9
percent among hypertensive individuals and strokes by
6 percent an morta eart attac s y 4 percent among
a u ts w t norma oo pressure. Journa Human
Hypertens on 16: 761-70, 2002
A stu y con ucte n Israe s owe a ow so um et
on y re uce oo pressure y 4 po nts rst num er)
among a u ts w t m ypertens on. J HumanHypertension 11: 765-66, 1997]
Surpr s ng y, w en government ea t researc ers
rev ewe a o t e stu es on etary so um an ea t ,
t ey cou on y n ev ence or a mo erate re uct on
in salt intake, certainly less than the current 4000 to
6000 mg per ay consume y many US a u ts, an
pro a y a out 2400 mg a y nta e. J Am Co ege
Nutr t on 16: 192-203, 1997
Lead
At eve s o nta e e ow current US occupat ona
exposure gu e nes, 40 m crograms per ay, ea s
associated with elevation of blood pressure and this
s pronounce among postmenopausa women. J Am
Me Assn 289: 1523-32, 2003 .
Iron
ron load (ferritin) is considered a risk factor for
elevated blood pressure. [Am J Clinical Nutrition 76
256-60, 2002 E evate ron storage s a so assoc ate
w t g oo sugar eve s w c n turn ra ses oo
pressure. En ocr ne Researc 29: 299-306, 2003
iddle-age males have about twice the iron load as
enstruat ng ema es an ave a g er preva ence or
ypertens on. J Hypertens on 20: 1513-18, 2002
any health practices that help to control blood
pressure, such as a vegetarian diet, juicing, teas, etc
or examp e, a water-on y ast or 14 ays as een
s own to re uce oo pressure to at east 120 80 n
2 percent o 68 pat ents w o a m ypertens on
The fast produced a drop of about 20/7 points. [J
A ternat ve Me c ne 8: 643-50, 2002 Fast ng re uces
ron consumpt on.
Copyright 2004 Bill Sardi, Knowledge of Health, Inc.
Peter S e g t MD, Pro essor Emer tus o
Car ovascu ar Me c ne at t e Un vers ty o
Ox or says “re ative y sma rops (2 to 5
points) in blood pressure in the whole population
—achieved by modest salt reduction—will do more
oo t an arger c anges pro uce y rugs in
e sma er group o a u ts wit ypertension.”
Me ca Tr une August 14, 1997