Chances are very good that you’ve been told you have high blood pressure — or are about to get it — and so need to take pills to keep your numbers down. Some 70 million Americans — a third of us — have been told we’re suffering from hypertension, and another third have been diagnosed with “pre-hypertension.” That’s two thirds of the population of the United States who supposedly should be on blood pressure meds.
Well, maybe not. Let’s listen in on what an expert from the University of Massachusetts Medical School has to say on the subject:
Notice that this gentleman was speaking in 2014. What he advises has been known for at least four years. And yet if you go to your GP for a check-up — or even to a trained cardiologist — you are likely to find yourself added to the majority of Americans put on anti-hypertensive medications.
You will be told, as I was, that if you don’t start taking these drugs immediately — and stay on them for the rest of your life — you are going to have a heart attack or a stroke. This, even if your blood pressure is fairly low — my systolic BP averages around 123.5.
One reason for this is the steady pressure on practitioners to diagnose hypertension and prehypertension, a campaign to convince them that patients are at risk if their numbers are above a certain level. Within the past year, that level has been dropped by ten points. Until just a few months ago, “normal” blood pressure was defined as a systolic reading of 120-129, and “prehypertension” was 130-139. Now, lo! We’re told numbers in the 120s indicate “elevated” blood pressure — and need to be treated — whereas numbers in the 130s are now defined as “Stage 1 hypertension.” This rejiggering of definitions puts a large new cohort into the category of “patients” who must be medicated. Or, we might say more realistically, makes them eligible for overtreatment.
But how beneficial are these medications?
Let’s check the Number Needed to Treat. Among people treated with anti-hypertensives, overall 1 in 125 were helped in that they did not die. Strokes were prevented among 1 in 67. One in 100 were helped in that they did not have a heart attack. But 1 in 10 were harmed. Obviously, one would like not to experience a cardiac event. But do you really want to be one of the 1 in 10 who are harmed by the drugs?
None of these drugs is completely benign. All of the classes of antihypertensives have side effects, which affect different people in different ways. You may experience no side effects. Or you may have one or two side effects that are so minimal they don’t bother you. The most common is hypotension, the result of overtreatment, leading to dizziness, fatigue, tiredness, and anxiety. However, the potential for serious side effects is there:
Calcium channel blockers
Peripheral edema (swollen ankles)
Abnormally slow heart action
Abnormally low potassium levels (hypokalaemia), which can lead to heart failure
Low levels of magnesium (hypomagnesaemia)
Abnormally low sodium levels (hyponatraemia), also potentially life-threatening
Glucose intolerance (a risk factor for mortality)
High calcium levels (hypercalcaemia), which can lead to abdominal pain, bone pain, confusion, depression, weakness, kidney stones, or arrhythmia (an abnormal heart rhythm including cardiac arrest)
Angiotensin receptor blockers (said to be the best tolerated of antihypertensive meds)
Wheezing or asthma,
Masking of hypoglycaemia
Worsening of peripheral vascular disease
Elevated triglycerides, cholesterol and/or fat phospholipids (dyslipidaemia)
Angina caused by sudden withdrawal.
Postural hypotension (sudden drop in blood pressure, causing dizziness or fainting)
Precipitation of heart failure.
Well, you think — as your doctor is telling you that if you don’t push your systolic blood pressure into the 110s, you’re going to drop dead of a heart attack or a stroke — maybe it would be better to risk or tolerate these unpleasant ailments than to die.
The fact is, despite the hype to the contrary, treating mild to moderate hypertension has not been shown to improve outcomes: it does not change rates of mortality or sickness. A recent study published by the widely respected Cochrane Group found that “No evidence of a difference in total mortality and serious adverse events was found between treating to a lower or to a standard blood pressure target in people with hypertension and cardiovascular disease. This suggests no net health benefit from a lower systolic blood pressure target despite the small absolute reduction in total cardiovascular serious adverse events. There was very limited evidence on adverse events, which lead to high uncertainty. At present there is insufficient evidence to justify lower blood pressure targets (≤ 135/85 mmHg) in people with hypertension and established cardiovascular disease.”
And that’s for people who have identifiable cardiovascular disease — not for the hordes of asymptomatic patients assigned to take these drugs.
Another effort to determine the benefits of treating low-level hypertension showed that “Antihypertensive drugs used in the treatment of adults (primary prevention) with mild hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) have not been shown to reduce mortality or morbidity in RCTs ” (randomized controlled trials; my emphasis). The authors continued, “Individuals with mildly elevated blood pressures, but no previous cardiovascular events, make up the majority of those considered for and receiving antihypertensive therapy. The decision to treat this population has important consequences for both the patients (e.g. adverse drug effects, lifetime of drug therapy, cost of treatment, etc.) and any third party payer (e.g. high cost of drugs, physician services, laboratory tests, etc.)…. Available data from the limited number of available trials and participants showed no difference between treated and untreated individuals in heart attack, stroke, and death. About 9% of patients treated with drugs discontinued treatment due to adverse effects.”
Note that this second study defined “mild” hypertension as 140-159/90-99 mmHg — and remember that today the American Heart Association would have us believe systolic readings of 120-129 are “elevated” and 130-139 are full-blown hypertension.
In 2017, another set of researchers found that treating people to lower blood pressure targets made no difference in cardiovascular outcomes: “We found and included three unblinded randomised trials in 8221 older adults (mean age 74.8 years), in which higher BP targets of less than 150/90 mmHg (two trials) and less than 160/90 mmHg (one trial) were compared to a lower target of less than 140/90 mmHg. Treatment to the two different BP targets over two to four years failed to produce a difference in any of our primary outcomes, including all-cause mortality (RR 1.24 95% CI 0.99 to 1.54), stroke (RR 1.25 95% CI 0.94 to 1.67) and total cardiovascular serious adverse events (RR 1.19 95% CI 0.98 to 1.45).” (My emphasis.)
As you can see, then, overtreatment of mild hypertension (or possibly of what we’re now told is serious hypertension) may be doing more harm than good. Even when “mild” or “stage 1” hypertension was defined as 140-49/90-99, there was no evidence that people at “low risk” (i.e., with no existing heart disease, diabetes, or kidney disease) are helped by going on antihypertensive medications. To the contrary, they are presented with a wide array of uncomfortable and even life-threatening drug side effects.
Meanwhile, for some years practicing doctors have been reporting rampant overprescription of these medicatons; one even called it “an epidemic” of hypertension overtreatment. Not to be left behind, the legal profession has noticed the phenomenon, too; one lawyer suggests, almost circumspectly, that Big Pharma and the money motive might be at the bottom of it all:
Unfortunately, big drugs are big business, and wherever money is involved, motivations can come into question when medications are prescribed to people who might not need them.“I think doctors are induced by pharmaceutical companies to use their products,” says medical malpractice attorney Andrew J. Barovick. “Whether they’ll acknowledge it or not, there’s often a quid pro quo.”
Whether or not doctors get paid for putting you on a given drug, there’s no question that the prospect of putting two-thirds of Americans on blood pressure meds represents a vast reservoir of profit for Big Pharma. That alone is reason to be skeptical.
Remember this principle: always get a second opinion.
This is the fourth of seven planned posts on The Drugging of America.
- What is NNT and how can you use it to assess the risks and benefits of a given treatment?
- The problem with treating “pre-conditions”
- Hyped hypertension: Medicating 2/3 of America
- Organizations and funding
- The “de-prescribing” movement in medical practice
- Lifestyle strategies to maintain good health without drugs