Hypertension is called the silent killer because it can occur with few if any symptoms. When hypertension is allowed to persist, it can set the stage for more serious heart disease and heart events.
Untreated hypertension results in the heart and blood vessels working harder and less efficiently. Patients who are diagnosed with heart disease are often put on one drug, which is titrated sometimes to a high dose, in order to control the high blood pressure. Inevitably, this can result in some less than wonderful side effects. A new study suggests that it may be possible to use more than one drug, at lower doses, in order to keep blood pressure controlled while limiting drug-related side effects.
The number of people predicted to be living with high blood pressure by 2025 is 1.56 billion. In the U.S., the latest statistics show that about 75 million people have hypertension. This number is based on data available on the number of people assessed for hypertension and also the number of people taking anti-hypertensives.
Control of hypertension is considered a national priority in the U.S., part of the Million Hearts initiative from the Department of Health and Human Services. By controlling hypertension and other risk factors, the program aimed to prevent one million heart attacks and strokes in the US in 2017.
With the increasing prevalence of the condition, there’s been a parallel increased use of medications to control the disease. As with all serious medications, there are unpleasant side effects that are a trade-off for control of the disease.
The study published in the journal, Hypertension, reviewed data involving over 20,000 patients, average age 54, who were on various doses of blood pressure-lowering drugs or on no medication regimens, at the time the data was collected. Of the subjects taking medications for blood pressure control, some were on standard full dose, some were on two drugs at quarter doses each, and some were on four drugs with each drug at quarter dose.
The researchers found that the consumers on the two drugs (quarter dose) had good blood pressure control, similar to one drug standard dose therapy. What was very interesting was that the patients on four drugs (quarter dose each) had almost twice the effective control of their blood pressure compared to the single drug standard dose. Combined quarter doses also had significantly lower side effects compared to single standard dose regimen.
There are five “standard or main” drugs used to treat hypertension. They include:
- ACE inhibitors – These medications slow or inhibit the action of angiotensin-converting enzymes, which helps to lower blood pressure and allow blood vessels to enlarge or dilate for better blood flow. They are used to treat acute and chronic hypertension. Most of the drugs in this group are quite similar. The only difference is how they are eliminated from the body, and doses prescribed.
- Angiotensin receptor blockers – These drugs block the action of angiotensin, specifically angiotensin II, from binding to the angiotensin II receptors on blood vessels. Angiotensin II cause constriction of blood vessels, so blocking its action allows the blood vessels to remain relaxed. These drugs are used alone or in combination with other blood pressure medications.
- Beta blockers – Also called beta-adrenergic blockers, they block the effects of the hormone epinephrine (adrenaline), which results in the heart beating more slowly and with less force, so blood pressure is reduced.
- Calcium channel blockers (CCBs) – These medications prevent calcium from entering the cells of the heart and the blood vessel walls, allowing the blood vessels to relax specifically by limiting muscle cell action. The muscle cells normally contract and pump the blood through the blood vessels.
- Thiazides – These drugs also called diuretics were classically a “first-line” drug in the treatment of hypertension. These drugs act on the kidneys to help promote urine flow. They decrease sodium reabsorption, helping the heart to work less and lowering blood pressure.
Despite the study’s findings, it’s too premature to make global recommendations without further research. Persistent hypertension can ultimately result in a heart attack, stroke or kidney failure.
Of course, you can lower the risk of developing hypertension with lifestyle changes including a diet like the DASH program, specifically avoiding certain foods, exercise and stress reduction, not smoking and reducing use of alcohol, which cumulatively will help to significantly limit hypertension. These efforts should be part of any blood pressure treatment program, even if medication is still needed.