New Hypertension Standards Are Bad

A Drug Cocktail That Benefits Very Sick People Is Being Paraded As A Major Breakthrough And Will Likely Be Widely And Inappropriately hyoertension-Pill CocktailApplied

It’s déjà vu all over again, as the late Yogi Berra is said to have said. It is almost normal that whenever a drug benefits a narrow cohort, it almost immediately gets thrown at a much wider one.

Ezetimibe is a perfect example. It is widely prescribed with statins, though it was only approved for people with extremely high cholesterol. (Extremely, in this case would be 300 mg/dl, 400 mg/dl, or even higher.) Does this practice help the more normal case? No. Hurt? Yes. It increases the risk of cancer. But it’s part

of a sort of unwritten standard of care now, propelled along by drug company marketing. How this could work is perplexing. Here is a prominent quote from a Zetia (ezetimibe brand) ad:
hypertension-zetia

Huh? This is a screen clip from a Zetia ad. We did not make this up. They admit the drug is useless, yet somehow manage to sell it. This is like the TV ad from years ago wherein a drug was pitched, opening with a reassuring : “I am not a doctor, but I play one on TV.” (Think we are making this up? It’s here.)

But this is peanuts compared to what is just around the corner. A study funded by the National Institute of Health, aimed at reducing blood pressure, has ended prematurely because the results were so good. The people in the trial had their blood pressure brought down to 120 by various combinations of drugs. They had fewer strokes, fewer heart attacks, and fewer deaths overall. Sounds like a win-win doesn’t it? They haven’t released results, but did do a press release which was picked up my the media with headlines. The New York Times: “Lower Blood Pressure Guidelines Could Be ‘Lifesaving,’ Federal Study Says.”

So what could possibly be the problem. Well the “problem” is that the people in the trial were very very sick. Here is the inclusion criteria: “SPRINT will enroll approximately 7,500 participants age 55 years or older with systolic blood pressure of 130 mm Hg or higher. Participants will have a history of cardiovascular disease; be at high risk for heart disease by having at least one additional risk factor, such as smoking or high blood cholesterol levels; or have chronic kidney disease.”

Short interpretation: “Those not already very sick need not apply.”

But wait. Surely if it helped these people it will help others.

Now unfortunately, the press release didn’t make any real efforts to say that this was for very sick people only. It was very dry. But this didn’t last long. The New York Times and many others spun it into the breakthrough of the century, embellishing it with interview of some of the researchers, all of whom were very excited, and so on. Hardly any space was devoted to reminding anyone that these results applied to a rather narrow, very sick cohort. And side effects? Well, there might be some. That was about it. Mums the word for now.

So What Is Going To Happen

We Predict: This drug cocktail is going to become standard practice and millions are going to be put on it. It will be pushed and pushed by big pharma. And years later, it will be sorted out that unless you were really sick, not just mild hypertension, there was no benefit. In fact there was harm. So put this one in your time capsule and open in it 10 or 20 years and see if we were right.

Why are we so sure. Three reasons:

First. For people with moderate hypertension, say 140 or even 160, no drug has found to have any benefit. The current recommendations are to not medicate. However, many, perhaps most, doctors will prescribe something anyway. The are far more people with mild hypertension, for whom the three drug cocktail is likely a bad idea, then there are high risk people. Again, we have the wide spread practice, aided and abetted by big pharma, of applying a drug to a cohort vastly beyond the one for which the drug was originally targeted.

Second. Blood pressure is not the disease. It is a symptom of another disease, atherosclerosis—clogged arteries. Blood pressure is high for a reason. Blood pressure is regulated. If the body wants, it can set that blood pressure anywhere from 50 to 250. Why is it where it is? So that enough blood can be push to the brain, or other key spots. If the blood pressure is reduced, these places don’t get enough blood. If it is reduced a lot, these places really don’t get enough. Reducing blood pressure does absolutely nothing to cure atherosclerosis.hypertension-dizzy

Third. The drugs themselves are ugly. Not something you want to be taking. The typical cocktail mentioned in the reports are:

  • -Diuretics. Associated with low sodium, dizziness, adult onset diabetes,
  • -Calcium Channel blocker. Associated with liver dysfunction, breast cancer, dizziness, and edema.
  • -ACE Inhibitors. Associated with kidney problems, dizziness, cough, tachycardia.

And these are the short lists. As we are forever and a day saying, association is not causation. But why in the world should moderately hypertensive people be subjected to such a nasty brew. It is very unlikely to help, and will almost surely harm.

There is a better way.

The disease is atherosclerosis, not high blood pressure. Keep this in mind, and keep it in your doctor’s mind as well. If your blood pressure isn’t dangerously elevated. Say above 160 or 170, do this: change your diet as described here, and undertake exercise as described here. These are the Quantitative Medicine protocols for reversing heart disease. They work, and involve no drugs. The only side effect are lowering of cancer risk, prevention of adult onset diabetes, prevention of Alzheimer’s, and slowing of aging. These are side effects most of us can live with.

If confronted with pills, counterattack with the above lifestyle changes. And mean it. Your doctor will be delighted if you reverse heart disease without pills.

  3 comments for “New Hypertension Standards Are Bad

  1. Jim
    September 26, 2015 at 4:30 am

    I think that sometimes part of the problem is the way so many people want the magic pill or elixir. We all like the thought of a cure-all. Big pharma knows this. So go ahead and live the lifestyle that puts you on the road to atherosclerosis and all of its comorbidities – we got your back when the time comes – just drink the cocktail (for the rest of you life) and all will l be abated.

    Sorry – a little cynical this morning. Think I’ll go out with my dog and enjoy the early-fall crisp morning – maybe even do some sprints.

  2. Nancy
    September 28, 2015 at 3:39 pm

    I’m sort of confused about what causes high BP. I had one of those heart scans and I have absolutely no (as in zero) atherosclerosis. I also tested for fabulous type A LDL, and have very good numbers. However, I have mild (140/85 highest) hypertension for over 10 yrs, suffered from Toxemia in pregnancy, and have a long history of family hypertension. So what makes the hypertension in someone like me who has clear arteries, and should it even be treated?

    • September 29, 2015 at 1:15 pm

      There are other vascular issues at play here; the first one I would turn my attention to is stress, relaxation and a well formed spiritual discipline. These types of activities address the neurohormonal components of high blood pressure. They are actually at play long before the actual ‘stiff’ arteries set in. Don’t treat blood pressure based on office based numbers; only treat pressures taken at home or better the results of a full 24 hour ambulatory blood pressure monitor readout. If, please note the ‘if,’ your high is 140/85 treatment is more toxic than the numbers themselves represent. Please keep in mind that a simple blog/email exchange cannot make a clear diagnosis or recommendation; I offer here a few other ways to think about the problem. Dr. Mike

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