Oregonian (Portland, OR)
June 06--Are people with borderline high blood pressure taking medication unnecessarily?
A study issued last year by the respected Cochrane Review raised that question. Now, it's getting new attention following a column in the journal JAMA Internal Medicine.
Doctors prescribe medication to prevent stroke, heart attack or kidney damage, because high pressure thickens and inflames artery linings.
The study and the skeptics challenge the conventional wisdom on mild hypertension, with blood pressure ranges that are considered high under today's standards: systolic of between 140 and 159, and diastolic between 90 and 99.
The Cochrane Review analyzed four studies and found that for people in those blood pressure ranges, medication did not result in lower rates of mortality or poor health.
In the JAMA column, Dr. Iona Heath of the United Kingdom calls for raising the levels at which medication is diagnosed, to 160 and 100. She notes the side effects and cost affiliated with blood pressure medication, and faults pharmaceutical industry influence for today's standards, calculating that the lower levels of 140/90 created 13 million new drug customers.
Her column has received praise from two influential health and science journalists, Gary Schwitzer and Paul Raeburn. But a doctor in Forbes rejected her conclusion, saying more science is needed.
The debate has been accompanied by a timely reminder of the unknown potential side effects of even popular medications: e-mails obtained by the Wall Street Journal recently showed a Food and Drug Administration management dismissed a staff member's concerns that top-selling blood pressure medications may significantly increase cancer risk. Those medications are candesartan (brand name Atacand), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), telmisartan (Micardis) and valsartan (Diovan).
You shouldn't discontinue a medication without consulting with your doctor. But the new spotlight on mild hypertension and blood pressure medications serves as a good reminder: if your hypertension fits the definition of mild, you probably can use exercise and dietary changes to improve those numbers, and consider getting off your medication.
What follows are links to relevant articles and commentary:
Waste and harm in the treatment of hypertension (JAMA Internal Medicine)
Journalism where you wouldn't expect it: JAMA Internal Medicine on treatment of mild high blood pressure (Knight Science Journalism)
Dispute Flares Inside FDA Over Safety of Popular Blood-Pressure Drugs (Wall Street Journal)
Are we over-treating high blood pressure? (Forbes)
13 Natural ways to lower blood pressure (ABC News)
An Ounce of Prevention -- Blood pressure medications (The North Haven Citizen)
Among the frail elderly, higher blood pressure might be a good thing (The Oregonian)
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