Hypertension Medications Not Harmless

By Joel Fuhrman, M.D.www.drfuhrman.com

All Patients Experience Significant Side Effects, Which Sometimes Include Premature Death!

The liberal use of medications in an attempt to reduce the hypertension caused by our toxic diets and sedentary lifestyles has created a unique set of risks.

Medications to lower blood pressure cause fatigue, lightheadedness, and loss of balance, leading to falls in the elderly, potentially causing hip fractures. They also can lower diastolic blood pressure excessively (as they lower systolic pressure), which increases the potential for cardiac arrhythmias that can lead to death. 2 The excessive use of blood pressure medications that lower diastolic blood pressure too low also have been shown to increase the occurrence of atrial fibrillation, another serious rhythm disturbance of the heart.3

Blood pressure medications increase the chances of developing diabetes. Since the 1960s, the metabolic side effects of beta-blockers have been widely studied. Beta-blockers have been shown to increase insulin resistance and predispose patients to diabetes. In a “network meta-analysis” of 22 clinical trials with 143,153 participants who did not have diabetes when the study began, the risk of developing diabetes was most pronounced in those persons using diuretics and beta-blockers, implying a negative metabolic effect of these medications. 4

In the elderly, high blood pressure is not a risk factor for mortality, irrespective of a history of hypertension. However, according to a June 2006 study that appeared in the Annals of Internal Medicine, blood pressure values below 140/70 mmHg (especially among those whose medications have pushed down their diastolic blood pressure too low) are associated with excess mortality in the elderly. 5 Because coronary artery filling occurs during diastole, people with coronary artery disease (which includes most elderly Americans eating the standard diet) are at increased risk for coronary ischemic events when diastolic blood pressure falls below a certain level. Over 22,000 patients were studied in this 14-country study, which found a striking increase in heart attacks in those who were on medications that brought the diastolic blood pressure below 84. Those with a diastolic blood pressure below 60 had three times the occurrence of heart attacks compared with those with a diastolic pressure above 80.

Pulse Pressure

Recent studies demonstrate that a high pulse pressure (systolic blood pressure minus diastolic blood pressure) is an important risk factor for heart disease. A meta-analysis published in 2000, which combined the results of several studies of 8,000 elderly patients in all, found that a 10 mm Hg increase in pulse pressure increased the risk of major cardiovascular complications and mortality by nearly 20 percent. 6Heightened pulse pressure (normal is 40 or less) also is a risk factor for the development of cardiac arrhythmias, such as atrial fibrillation. This helps to explain the apparent increase in mortality associated with low diastolic pressure, and why medications for high blood pressure actually may increase the pulse pressure and the risk of heart disease.

As people get older, their blood vessels develop more atherosclerosis, stiffen, and lose elasticity. A healthy blood vessel expands in systole and contracts in diastole, keeping systolic blood pressure lower and diastolic blood pressure higher. So a lower diastolic blood pressure in an elderly person is not a favorable sign. And when drugs force systolic blood pressure even lower, the risk of ischemic events and clot formation increases. This is one of the reasons why blood pressure medications have not been shown to have favorable effects at reducing heart attack risk in people over the age of 85. In this age group, lowering blood pressure below 140/70 with drugs has been demonstrated to increase, not decrease, mortality. 7 Drugs do not restore elasticity to the blood vessels; only diet and exercise can do that.

Problems With Beta-Blockers

The AHA recommends beta-blockers, along with diuretics, as first-line treatments for people with high blood pressure. Beta-blockers can cause fatigue, sexual impotence, lower exercise tolerance, weight gain, and increased risk for diabetes. But those problems aren’t the worst of it. Recent studies show that betablockers, taken by millions, cause more harm than good for most people taking them.

In the large POISE trial, conducted in 23 countries, all 8,351 enrolled patients met at least one of the following criteria: history of coronary disease, stroke, or peripheral vascular disease; recent hospitalization for heart failure; currently undergoing major vascular surgery; or any three of seven other risk criteria outlined in the protocol.

Postoperatively, patients received metoprolol (a common beta-blocker) or placebo for 30 days. After 30 days, overall mortality (death) was higher in the group treated with the beta-blocker (3.1 percent vs. 2.3 percent). and the drug-treated group had almost double the incidence of stroke.8 Additional analyses did not identify any subgroup that benefited from metoprolol. The study showed that artificially lowered blood pressures had clear risks and that the drugs caused more harm than good. Add to this the fact that there is no data to suggest these drugs prevent heart attacks in healthy people with mildly elevated blood pressures, and you have to wonder why beta-blockers are so widely prescribed.

The latest review of the evidence was presented in the August 14, 2007 issue of the Journal of the American College of Cardiology. 9 Despite three decades of using betablockers for hypertension, the authors of this state-of-the-art paper noted that no study has shown that beta-blocker therapy reduces morbidity (disease suffering) or mortality (death) in hypertensive patients.

This comprehensive meta-analysis indicates that in patients with uncomplicated hypertension compared with other antihypertensive agents, beta-blockers were associated with an increased risk of stroke (and the risk of stroke was even worse in the elderly on beta blockers), with no benefit for the end points of all-cause mortality or cardiovascular morbidity and mortality. The conclusion of this comprehensive analysis of all research studies on beta-blockers was this: Given the increased risk of stroke, their “pseudo- antihypertensive” efficacy (failure to lower central aortic pressure), lack of effect on regression of target end organ effects (such as left ventricular hypertrophy and endothelial dysfunction), and numerous adverse effects, the risk–benefit ratio for beta-blockers is not acceptable for routine blood pressure lowering. The Cochrane Review found the same thing. 10It can’t be denied; prescriptions written for beta-blockers to lower blood pressure do no good.

Unfortunately, in spite of the evidence, physicians still perceive betablockers to be exceedingly efficacious antihypertensive drugs. Betablockers are the fourth most commonly prescribed drug in the U.S. and account for over $2.8 billion in sales worldwide. In a recent survey, physicians were asked, “Which of the following classes of drugs have been proven to reduce the risk of stroke in hypertensive patients?” Beta-blockers were considered the most effective class by a large margin. They also were asked, “Which of the following classes of drugs have been proven to reduce mortality in hypertensive patients?” Beta-blockers were rated highest.

These misperceptions are the long lasting results of deceptive marketing by the pharmaceutical industry, which touts beta-blockers as “cardioprotective.” They are unfortunate at the very least—and they are potentially deadly.

The AHA’s Council for High Blood Pressure Research and the European Society of Hypertension/European Society of Cardiology are no longer endorsing beta-blockers as a first line treatment for uncomplicated hypertension.

(Note: If you choose to get off your beta-blockers, keep in mind they have to be discontinued gradually and the dose lowered little by little.)

Calcium Channel Blockers

Since beta-blockers are ineffective and dangerous, and diuretics increase the risk of diabetes and can make you fall down, you might think that calcium channel blockers are a better option. Unfortunately, calcium channel blockers could be an even worse choice of medication than beta-blockers for some people.

Incredible as it sounds, as reported in the December 15, 2004 issue of Journal of the American Medical Association, these commonly prescribed blood pressure medications almost double your risk of dying of cardiovascular disease (CVD) such as heart attacks and congestive heart failure. 11This huge study followed 93,676 women, aged 50-79 years at baseline for six years and found the women treated with a diuretic plus a calcium channel blocker had an 85% greater risk of CVD death versus those treated with a diuretic plus a beta-blocker.

Calcium channel blockers have not been found to prevent heart attacks better than diuretics. In fact, a meta-analysis of all studies combined showed that treatment with calcium channel blockers did not decrease the risk of heart attacks or heart failure, and were inferior in this regard compared with angiotensin converting enzyme (ACE) inhibitors. 12 In spite of this, calcium channel blockers continue to be a blockbuster success for the drug industry, with sales in the billions of dollars.

Unbelievably, calcium channel blockers are not the most worthless drugs in the anti-blood pressure medical arsenal; actually, alphablockers likely are even worse. Alpha-blockers do not reduce morbidity and mortality in hypertensive patients, and are well-known to cause a variety of poorly tolerated side effects.13

“Safer” Medications

If drugs are the only option. then ACE inhibitors, ARBs (Angiotensin II Receptor Blockers), and diuretics are the preferred medications. But they also have serious side effects.

ACE inhibitors can cause a persistent cough in 10-15 percent of patients. If that happens, they should be discontinued. Another serious problem with ACE inhibitors is that they can cause kidney damage, especially if overdosed and the blood pressure gets too low. When patients begin my nutritional protocols for blood pressure reduction, care has to be taken to reduce or remove the ACE inhibitor so that the kidney is not damaged. ARBs have the fewest side effects of the blood pressure medications, but are not very effective at lowering blood pressure.

Low Blood Pressure

Any medication that lowers blood pressure has the potential to cause dangerously low blood pressure, fatigue, and dizziness. Many men are painfully aware that all blood pressure- lowering drugs can cause impotence (erectile dysfunction).

Additional Side Effects

In addition to the side effects already mentioned, here are some of the other side effects that are associated with the various medications—ARBs: headaches, muscle weakness, flu-like syndromes, increase in potassium, and worsening kidney function; Diuretics: lower potassium, gout, and sexual impotence; ACE inhibitors: cough, kidney damage, skin rash, and loss of taste; Calcium channel blockers: swollen ankles and feet, leg pain, constipation, headaches, flushing, heartburn, and numbness or tingling in hands and feet.

Mixed Blessing At Best

Blood pressure-lowering drugs may reduce stroke risk by about 30 percent, but because they increase the risk of heart failure and fatal heart attacks, their overall reduction in mortality is minimal. The obvious conclusion is that whatever paltry benefits drug therapy may bring, thy pale in comparison with the safe and dramatic benefits derived from lowering blood pressure with diet and exercise.

References:

2. Swaminathan RV, Alexander KP. Pulse pressure and vascular risk in the elderly: associations and clinical implications. Am J Geriatr Cardiol 2006;15(4):226-32; quiz133-134.

3. Mitchell GF, Vasan RS, Keyes MJ, et al. Pulse pressure and risk of new-onset atrial fibrillation. JAMA 2007;297(7):709-715.

4. Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network metaanalysis. Lancet 369:2007;201-207.

5. Messerli FH, Mancia G, Conti CR, Hewkin AC, Kupfer S, Champion A, Kolloch R, Benetos A, Pepine CJ. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med 2006 Jun 20;144(12):884-893.

6. Blacher J, Staessen JA, Girerd X, et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med 2000; Apr 24;160(8):1085-1089.

7. van Bemmel T, Gussekloo J, Westendorp RG, et al. In a population-based prospective study, no association between high blood pressure and mortality after age 85 years. J Hypertens 2006;24(2): 287-292.

8. POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing noncardiac surgery (POISE trial): a randomized controlled trial. Lancet 2008;DOI:10.1016/S0140- 6736(08)60601-606017.

9. Bangalore S, Messerli FH, Kostis JB, Pepine CJ. Cardiovascular Protection Using Beta-Blockers. J Am Coll Cardiol 2007;50(7):563-572.

10. Wiysonge CS, Bradley H, Mayosi BM, et al. Beta-blockers for hypertension. Cochrane Database Syst Rev 2007;(1):CD002003.

11. Wassertheil-Smoller S, Psaty B, Greenland P, et al. Association between cardiovascular outcomes and antihypertensive drug treatment in older women. JAMA 2004 Dec 15;292(23):2849-2859.

12. Furberg CD, Psaty BM, Pahor M, et al. Clinical Implications of Recent Findings from the Antihypertensive and Lipid-Lowering Treatment To Prevent Heart Attack Trial (ALLHAT) and Other Studies of Hypertension. Ann Intern Med 2001;135(12):1074-8. Doggrell SA. Has the controversy over the use of calcium channel blockers in coronary artery disease been resolved? Expert Opin Pharmacother 2005;6(5):831-834.

13. Messerli FH, Grossman E. Therapeutic controversies in hypertension. Semin Nephrol 2005;25(4):227-235. References

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