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Aggressive hypertension treatment does not lead to dangerous drops in blood pressure

December 2, 2020

About the Author

photo of Alyson Kelley-Hedgepeth, MD

Alyson Kelley-Hedgepeth, MD, Contributor

Alyson Kelley-Hedgepeth, M.D. is a full-time cardiologist and co-director of the Women’s Program at Lown Cardiovascular Group. She has extensive experience in managing coronary artery disease, heart failure and arrhythmias. Dr. Kelley-Hedgepeth is committed to providing … See Full Bio
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Rumi Farhad Ara
December 8, 2020

It is very difficult to treat severe hypertension in mid trimester pregnancy with medication available at now. That is a real challenge for obstetricians.

Kevin Jorgensen
December 8, 2020

This article ignores the significant side effects of all blood medications. Using multiple blood medications increases the risk of a serious side effect that can impact quality of life significanty

December 7, 2020

Aggressive hypertension treatment does not lead to dangerous drops in blood pressure.This was happend to me.Now I understood ,thank you.

Eva Pardee
December 7, 2020

So what do you do if you have high blood pressure and you cannot take the appropriate dose of medication to control it because of severe side effects? Even after trying numerous medications. It seem this topic is never addressed. Side effects seem to be just swept under the rug by doctors even though they can be very severe.

December 7, 2020

Aggressive hypertension treatment to bring the blood pressure to a desired level free of I’ll affects of even if there is postural hypotension should be evaluated with comorbidities and can not be as simple as an observation of a meta-analysis.
Present contagion has raised horrifying issues in aged with Metabolic Syndrom where in postural hypotension is an important finding attributable to anti- hypertensive drugs, convalescence, Covad-19 induced dysautonomia, stress and multiple organ involvement challenging body homeostasis.

Kittredge White, PA-C
December 7, 2020

I read with great interest your blog post on aggressive lowering of blood pressure not leading to dangerous lowering of BP. Your article focused mostly on concerns for falls with too-aggressive lowering of BP.

When working as a PA in a community clinic, I saw a 73 yo lady with BP of 200/# (I forget the diastolic, but was very concerned about that systolic). I went to my SP to discuss, and to ask him if we had anything in-house we could give her to bring her pressure down a bit. He gave me a very hard time, saying that dropping pressure too quickly could lead to lowered end-organ perfusion – which made sense to me – and he wanted me to give her an Rx and send her home, with instructions for f/u. He produced an Up-to-Date article supporting his POV.

Because of my own concern and discomfort with sending her home, I sent her to the ED for care and monitoring.

What do your resources say about the concern for diminished end-organ perfusion with aggressive intervention for hypertension?

Donald E Morisky
December 7, 2020

One of the most important confounders in clinical trial studies is medication-taking behavior (adherence). Many clinical trials fail to measure this very important behavior, which may result in a misdiagnosis of the blood pressure. All patients should be measured on their level of adherence to rule out any differences between the two groups. This baseline measure can be measured at different periods of the study. Measuring adherence allows the investigator to correlate the adherence measure with the physiological outcome, blood pressure control. Most studies find the higher the adherence the higher the proportion of patients having their BP under control. Patients in the treatment group may receive educational counseling and this may make a big difference in final outcome.

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