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About the Authors
Daniel Kirshenbaum, MD, Contributor
Hanna Gaggin, MD, MPH, Contributor
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Can someone explain the difference between statistical benefit and clinical benefit? For example, say the increased risk of a heart attack or stroke between 120/80 and 140/90 is 10%. And the risk of a heart attack or stroke for someone with BP @120/80 is 5%. Does that mean that for a give person at BP 140/90 their risk increase 10%, from 5% to 5.5%? If so, then out of 1,000 people controlling their BP with medication to 140/90 instead of 120/80, an additional 5 will have a heart attack or stroke. This would mean for a given individual there is a 99.995% chance that the extra medication won’t have a positive impact, but a 100% chance that the body will be affected by the meds. Am I getting this right?
My own PCP did not like to give me much medicine to lower my elevated blood pressure, since he thought a lower pressure might increase my changes of falling–a big risk for older people. I’m 86 years old. So I’d like your longer study to see (inter alia) whether the fall risk went up as the BP went down in older adults. PLEASE.
OK 2/3 gave up medications for BP and there was no significant change in their BP. However, the ultimate decision to deprescribe excess medication is left hanging because you did not state long term consequences such as an attack , of course there are no such long term effect or longitudinal studies. Any idea how soon we can tell that you don’t need these x,y,z medications without fear of more consequential issues to the BP person?
Any older person with blood pressure 140 and under should not be on any blood pressure meds. As blood pressure varies throughout the day, it is a far more dangerous situation to have the blood pressure drop to the extent that they pass out and fall. As falls are a much more debilitating event.
The implication from the study could be also that the extra blood pressure medication should not have been prescribed. I wonder how many studies of sequential prescriptions show the clear extra benefits and side effects? How many doctors prescribed more than one pill initially? Also, how many patients had white coat hypertension?
I’m a 73 year old male on a number of medications to control my BP which averages around 140/80 so this article is very relevant for me. After I read your Controlling Your Blood Pressure report I’m going to talk to my cardiologist about possibly reducing the number of medications I take and what he thinks my BP goal should be. Thanks for the article.
I am 79 y and on dialysis. I was very unwell as a result or the side effects of my prescribed drugs (these included 8mg doxazosin, 10mg felodipine, and 5mg Bumetanide. My eGFR was 6% and my BP was constantly above 175/60. I hypothesized that my overworked heart was receiving messages from my kidney requesting an increase in the blood pressure to enable the supply of blood in the hylar to be re-established. Of my own volition, I stopped all BP related drugs and retained only the sertraline (150mg down to 100), the alfacalcidol 100mcg, and the allopurinol 200mg down to 100mg daily, plus levothyroxine 100mcg.
The outcome was startling. My BP is now around 145/65 and my quality of life is vastly better in all respects.
It is not clear whether age related hardening of blood vessels contribute to higher BP. IF so, whether medications will relax the hardening and restore the blood vessels to more flexible condition to facilitate smoother blood flow and reduce BP.
Trouble is there are many studies on drug effects but not enough on drug stoppage & possibly rebound effects when the condition treated returns even worse than before the drug was used. We need more studies like the ones on aspirin that show what effects stopping drugs have.
In SPRINT, intensive sBP control (<120) reduced the risk of mild cognitive impairment (MCI), and a composite outcome of MCI+probable dementia compared to standard sBP control (<140) among adults age 50 or older w/o diabetes or stroke. The trial ended early because the cardiovascular endpoints were met. Since most people have MCI before developing dementia, this was an important finding, and is worth part of the discussion about reducing pill burden. JAMA. 2019;321(6):553-561. doi:10.1001/jama.2018.21442
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Controlling Your Blood Pressure
An alarming one in three American adults has high blood pressure. Known medically as hypertension, many people don't even know they have it, because high blood pressure has no symptoms or warning signs. But when elevated blood pressure is accompanied by abnormal cholesterol and blood sugar levels, the damage to your arteries, kidneys, and heart accelerates exponentially. Fortunately, high blood pressure is easy to detect and treat. In the Special Health Report, Controlling Your Blood Pressure, find out how to keep blood pressure in a healthy range simply by making lifestyle changes, such as losing weight, increasing activity, and eating more healthfully.
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