Should all older people be on high blood pressure drugs?
All adults over a certain age should be offered drugs which lower blood pressure, according to the authors of a major new study. It found that blood pressure drugs can reduce the risk of heart attacks and strokes in older adults, regardless of what their blood pressure measurement was to begin with.
What do we know already?
Heart attacks and strokes are the leading cause of death in the UK. Among 65-year-olds in England and Wales, about 10 per cent of men and 5 per cent of women will have a heart attack in the next 10 years, and about 5 per cent of men and 4 per cent of women will have a stroke. As you get older, your risk of having a heart attack or stroke increases.
In most people blood pressure starts to climb as they grow older, but it may not be considered high by current guidelines. If your blood pressure becomes too high, it can damage the walls of the blood vessels, increasing the risk of a heart attack or stroke. Treatment for high blood pressure includes changes in lifestyle (diet, exercise, stopping smoking) and medication. What treatment your doctor recommends will depend on how high your blood pressure is, as well as other factors.
At present, blood pressure drugs are used to reduce high blood pressure to a specific target level. But some studies suggest these drugs should instead be prescribed based on the overall risk of cardiovascular disease, regardless of blood pressure. This would mean most older people would be offered these drugs.
Researchers have now explored this issue in the largest-ever review of blood pressure studies.
What does the new study say?
Researchers looked at 147 blood pressure studies, involving more than 464,000 people aged 60 to 69. The studies focused on 5 major types of blood pressure drugs: thiazides, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and calcium-channel blockers.
The researchers did a meta-analysis, which means they combined the studies’ results to see what conclusions they could draw from the research as a whole. They looked specifically at what happened when drugs lowered systolic or diastolic blood pressure by a given amount. (Systolic pressure is the top number of a blood pressure reading and gives the pressure when the heart pumps the blood out. Diastolic pressure is the bottom number, which is the pressure when the heart is relaxed).
They found that:
- Lowering blood pressure by a given amount reduced the risk of heart attacks by about a quarter and stroke by a third.
- These improvements applied to everyone, regardless of whether their blood pressure had been diagnosed as high before treatment.
- All 5 drugs worked well for reducing the risk of heart attacks and strokes.
- The risk of heart attacks and strokes continued to decrease as blood pressure dropped even lower. This suggests, say the researchers, that doctors should adopt a ‘lower is better’ approach to managing blood pressure, rather than trying to reduce blood pressure to a target level and keep it there.
Tell me more about the study’s findings
The researchers also looked at how combining three drugs at half doses might affect the risk of heart attacks and strokes. To do this, they merged their results with those of 2 other studies.
They found that using 3 drugs at half doses could cut the risk of heart attacks and strokes by twice as much as using 1 drug at a standard dose. This provides support, say the researchers, for offering a ‘polypill’ to anyone with a higher risk of these problems, including most older people.
How reliable are the findings?
These findings are based on a large number of studies, with nearly half a million people in total. This gives substantial weight to the results. However, combining the findings of so many studies can be problematic, as there are differences in how the studies were conducted and what types of patients they included. This leaves room for error and misinterpretation.
The research did not report on the side effects of blood pressure medicines. From other research, we know these can include dizziness, tiredness, sexual problems, and nausea.
Another drawback is that the study doesn’t compare the effects of offering drug treatment to all older adults with the effects of lifestyle advice, such as exercise, reducing salt levels, dietary changes, and stopping smoking.
The study’s conclusions on combining drugs are less reliable, as no studies have actually looked at using 3 blood pressure medicines at half doses. The researchers based their findings on the assumption that combining these drugs would add up to a larger benefit, but we need more studies to know if this is correct.
Where does the study come from?
The study was done by researchers at the Wolfson Institute of Preventive Medicine, at Barts and The London School of Medicine and Dentistry. It was published in the British Medical Journal (BMJ), which is owned by the British Medical Association.
Two of the authors hold patents (granted and pending) on the formulation of a combined pill to reduce four risk factors for heart attack and strokes, including blood pressure.
What does this mean for me?
If you are an older adult, this study suggests you may benefit from taking blood pressure drugs even if your blood pressure isn’t considered high. In future, you might even be offered a ‘polypill’ that combines low doses of different blood pressure drugs to help prevent heart attacks and strokes. However, the guidelines on who and who should not be treated with blood pressure drugs are unlikely to be changed at present.
What should I do now?
You don’t need to do anything as a result of this study. But if you are concerned about your risk of having a heart attack or stroke, be sure to talk to your doctor. You can have a risk assessment to estimate your chances of heart attack or stroke. This will look at a range of risk factors such as your exercise levels, weight, and family history, as well as your blood pressure. All adults over 40 should have a risk assessment, and adults of all ages with a strong family history of early heart disease or stroke should have one.
From:
Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338: b1665.
On the surface you’d think: ‘Hey, that’s a good idea. Put everyone on these mild multi-drugs and save lives!’
Read a little closer and its starts to appear more sinister.
First, how many subjects in the test? Answer: “a large number”. That could mean anywhere from 5 to 5,000. Vague answers are simply evasions.
A: The Wolfson Institute of Preventive Medicine – two of the authors hold patents (granted and pending) on the formulation of a combined pill to reduce four risk factors for heart attack and strokes, including blood pressure.
In other words, this study is anything but objective. If accepted by the medical community the authors may become multimillionaires overnight.
This article is indicative of how the entire medical industry shifted its central role of caring and healing sick people to becoming a giant dispenser machine for the pharmaceutical industry.
Don’t expect the Wolfson Institute of Preventive Medicine to champion exercises and diets to live healthy and long. There’s no money in that!
Excuse my cynicism but the more I examine the fine print in the goings on of the medical establishment (and the world in general) the more suspicious and cynical I become.
