Drug Therapy for High Blood Pressure

A two – decades long study of heart disease risk showed that reducing systolic blood pressure below 120 mm Hg (millimeters of mercury) provides no additional benefits for people with high blood pressure.

The lead author of the study was Dr. Carlos Rodriguez, associate professor of public health sciences at Wake Forest Baptist Medical Center in Winston-Salem, NC.

Dr. Rodriguez expressed surprise at the findings as he had expected to see a linear relationship between blood pressure and cardiac health outcomes.

There was a linear relationship, but it leveled off once the systolic pressure dropped below 140 millimeters of mercury.

Systolic pressure is the top number in a standard blood pressure reading – for example 120/80.  The systolic pressure represents pressure in the arteries when the heart muscle contracts.

The study clearly showed that people with high blood pressure have a greater risk of heart attack or stroke and that the risk increases as blood pressure rises.

People with systolic pressure between 140 to 159 had a 16 percent greater risk of a heart problem, while people with systolic pressure 160 or higher had a 73 percent increased risk of heart attack or stroke.

As Donna Arnett, immediate past president of the American Heart Association notes “clearly, exceeding 140 was not good. If you exceeded 160, it was worse”.

Dr. Rodriquez adds “”When the blood pressure goes below 140, there are definite cardiovascular health benefits. We saw a significant reduction in events,” These findings suggest that you don’t need to go lower than that to receive those benefits.”

A large-scale clinical trial sponsored by the National Institutes of Health is currently under way that will test these new findings, published online June 16 in JAMA Internal Medicine.

Dr. Andrew Freeman, assistant professor of cardiology at National Jewish Health in Denver, states “we may be less aggressive in terms of how fast or how much we push the pedal to the metal, so to speak”.  He added that if a new patient shows good results with one medication, doctors may be less inclined to add another.

My Thoughts:

What surprised me the most about this article was the fact that Dr. Rodriguez was so surprised at the results.  Back in 2009,  Dr. John McDougall wrote extensively on how he treats his patients with high blood pressure.  In Dr. McDougall’s article, he refers to a review by the Cochrane Collaboration which concluded that treating patients to lower than standard BP targets, < 140-160/90-100 mmHg, does not reduce mortality or morbidity.

Actually, Dr. McDougall has written extensively about the J-Curve of Mortality as it relates to blood pressure treatment with medications. He writes:

“Many studies of people treated for elevated blood pressure with medications have shown that when blood pressure is reduced below a certain level, risk of serious trouble (heart attacks, strokes and deaths) will increase.  This relationship is referred to as a “J-shaped” curve.  Meaning: lowering the pressure to a certain point is beneficial (that is the first part of the “J” shape), but beyond that point, the patient is harmed (the second part of the “J”) when the pressure is lowered further toward “normal.”  This phenomenon is found with both systolic (top number) and diastolic (bottom number) pressure changes.”

It’s important to remember that high blood pressure, like obesity and hypercholesterolemia (high serum cholesterol level), is a symptom of an unhealthy lifestyle – it is NOT a disease.   High Blood Pressure is usually the result of damaged arteries which will not be healed with anti-hypertensive drugs.

Dr. McDougall and other lifestyle medical doctors have had great success in normalizing the blood pressure of hypertensive patients by helping them transition to a WFPB diet.  When a person’s blood pressure normalizes while eating a WFPB diet, it normalizes as the person gets healthier.

By living an active WFPB lifestyle, we give ourselves the best chance of preventing the arterial damage that often reveals itself with elevated blood pressure.  This in turn gives us the best chance to avoid heart disease and strokes.

Lowering blood pressure with drugs involves interfering with normal biological coping responses that artificially lower blood pressure.  Various blood pressure medications affect different coping mechanisms.  Each of these medications bring their own side effects and aggressive treatment with these medications can be very problematic (as the J-Curve of Mortality shows).

This is why Dr. McDougal writes:  “a doctor should never brag that his patient had a normal blood pressure from intensive drug therapy during the many months prior to his stroke or heart attack”.

If you’ve been diagnosed with high blood pressure and are on medications, you may not have to be on them for the rest of your life.  Make sure you work with your Doctor as you transition to a WFPB diet.  Only your Doctor will know when it is appropriate to reduce or eliminate your blood pressure medications.

Dr. McDougall has thoroughly researched blood pressure medications.  He doesn’t automatically accept the propaganda from pharmaceutical reps.

If you want to learn more about Dr. McDougall’s views on the various blood pressure medications, I strongly encourage you to click here.  If you’d like to learn more about the J-Curve of Mortality, click here.