Friday, November 2, 2018

Study Questions Whether Treating Mild Hypertension Benefits Patients

For low-risk patients with mild hypertension, starting antihypertensive drug treatment might not reduce mortality, according to a JAMA Internal Medicine study. The American College of Cardiology and American Heart Association currently recommend that all patients with systolic blood pressure at or above 140 mm Hg or diastolic BP at or above 90 mm Hg receive antihypertensive therapy.

Using U.K. electronic medical records, researchers matched 19,000 adults with mild hypertension (140/90-159/99 mm Hg) and low cardiovascular risk who received antihypertensive medication to another 19,000 who weren't treated. During a median 6 years' follow-up, rates of mortality and cardiovascular disease were similar between the groups. Antihypertensive treatment was, however, associated with higher risk for hypotension, syncope, electrolyte abnormalities, and acute kidney injury.

My Take:
The controversy over treating borderline hypertension escalated when the two organizations noted above reduced the systolic and diastolic levels at which medication should be prescribed. They recommended a full cardiac workup for these patients as well.

Mild hypertension responses well to simple lifestyle changes – exercise, weight loss, and healthier eating habits. Supplementation of vitamin B2 and B3, magnesium or Co Q10 can also be effective. Sometimes something as simple as increasing the quality or quantity of sleep will lower BP to normal levels.

Hypertension medication is a slippery slope. It is, in fact, how most people begin taking prescription medication. Once it starts, it rarely stops and additional medications soon follow.

Typically, a calcium channel blocker, beta blocker or ACE inhibitor are prescribed to reduce BP. As the drug alters the physiology of the body, edema develops in the legs and lungs. A diuretic is then added to the hypertensive medication to draw some of the edema off of the body. However, this creates a potassium deficiency, so a prescription potassium supplement is added. 
The potassium irritates the stomach creating symptoms of GERD (gastroesophageal reflux disease) so a proton-pump inhibitor is added. Now you have the average American patient taking 4+ medications daily.

This brings us to the topic of acute kidney injury associated with the use of hypertension medication. In fact, all of the medications I noted above are associated with acute kidney injury.

The eGFR (estimated glomerular filtration rate) is normally above 95. This indicates healthy kidneys. However, levels between 60 and 95 indicate loss of kidney function without kidney damage. Levels below 60 indicate kidney damage. Clinically, the more medication a patient takes, the lower the eGFR. Patients on polypharmacy (5 or more medications) will have an eGFR below 60. Typically, patients taking just hypertensive meds with run in the 70s.

Bottom Line:
If your blood pressure is in the mild hypertensive range, consult with a nutritionist. However, supplementation will only help temporarily. You need to improve your lifestyle, loose that extra weight and exercise regularity to avoid hypertension long term.

October 30, 2018 New England Journal of Medicine

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