Am I locked into blood pressure meds for life?
A Second Opinion
meds for life. I can't tell you how odious that notion is to me.
Something he said that was of concern to me was that supposedly the
cause of high blood pressure isn't known. Granted I need to lose some
weight and my diet could be better but he was adamant that even if I
lose weight, make dietary changes - caffeiene, sodium, I need to take
the meds for life. Exactly the "beholding to the pharmaceutical
companies" path I do not want to be on.
Any thoughts on this? One can never get off bp meds?
Jerry
wrote:
> Doctor tells me I've got high blood pressure and that I need to be on
> meds for life. I can't tell you how odious that notion is to me.
That's a hell of a lot better than reducing or quitting animal source
foods and generally living healthier. Anyone who avoids animal fats
(which clog blood vessels) is a kook. Much better to conform than to
live healthy. Besides, being healthy is no fun. If you want to have
fun you gotta be sick.
And besides that, think of the medical and drug professions. They
gotta make a living. Are you trying to put them out of business?
b...@cs.toronto.no-uce.edu
There are a lot of factors that can contribute to high blood pressure.
Some people can reduce their blood pressure to healthy levels by
losing weight or reducing salt consumption or eating a better diet or
getting more exercise or learning relaxation methods or a combination
of these changes. Unfortunately, there are some people whose elevated
blood pressure can't be controlled this way -- they are thin, eat
a healthy diet, exercise, etc, but their blood pressure is still high.
Improving your lifestyle may help lower your blood pressure, but if it
remains high despite these changes, you may have to continue to take
drugs, odious or not, since the alternatives are even more odious --
kidney failure, strokes, etc.
Some doctors have found that most people just won't make permanent
lifestyle changes and have gotten kind of jaded about recommending them.
If that's the case with your doctor, you may want to find another,
especially if your blood pressure without the meds isn't all that high.
But if it's very high, while lifestyle changes may not be enough to
completely control your hypertension, they will improve your health in
other ways and you may not need as high a dose of the drugs.
It's easy to ignore hypertension because it doesn't seem to have any
real symptoms. Unfortunately, once you do get symptoms, a lot of
permanent damage has been done, and there isn't much that can be done
about it. It's important that you monitor your blood pressure, and keep
it in a safe range by whatever means is necessary.
Jason
<772c5fe1-f71e-48bc...@e20g2000vbb.googlegroups.com>, A
Second Opinion <asecond...@yahoo.com> wrote:
It may be possible to go off blood pressure medications if you are able to
change your diet and start an exercise program. In addition, cutting back
on sodium and caffeine will also help. One of the best things for you to
do is to read the following two books.
STOP INFLAMMATION NOW by Richard M. Fleming, M.D. (cardiologist)
REVERSE HEART DISEASE NOW by Stephen T. Sinatra, M.D. and James C. Roberts, M.D.
Dr. Sinatra and Dr. Roberts are cardiologists.
Bill who putters
<772c5fe1-f71e-48bc...@e20g2000vbb.googlegroups.com>,
A Second Opinion <asecond...@yahoo.com> wrote:
Here is some stuff to ponder.
Bill
...........
HYPERTENSION
Reducing heart rate in hypertension is harmful�or is it just atenolol?
OCTOBER 22, 2008 | Lisa Nainggolan
New York, NY - Slowing the heart rate with beta blockers in people with
hypertension is associated with an increased risk of cardiovascular
events and death, a new systematic review shows [1]. Furthermore, the
slower the heart rate, the greater the risk, report Dr Sripal Bangalore
(St Luke's Roosevelt Hospital, New York) and colleagues in the October
28, 2008 issue of the Journal of the American College of Cardiology.
What we show is that in hypertension, when you slow down the heart rate
with a beta blocker, it actually shortens your life.
Senior author Dr Franz Messerli (St Luke's Roosevelt Hospital) told
heartwire: "Slowing heart rate is known to prolong life expectancy, and
with beta blockers post-MI and in heart failure, the slower you can make
the heart rate, the better. But this new paper goes against the grain.
What we show is that in hypertension, when you slow down the heart rate
with a beta blocker, it actually shortens your life expectancy, it
causes more heart attacks, more heart failure, and more strokes."
Messerli says he and his team believe the likely explanation for this is
"that slowing the heart rate with beta blockers increases the central
pressure, and obviously the latter is one of the determinants of stroke
and heart attack."
Another hypertension expert sees things slightly differently, however.
Dr John Cockcroft (Wales Heart Institute, Cardiff, UK) argues that in
this review, the studies included almost exclusively used
atenolol�something the authors do point out�and that it is this drug per
se that is likely the culprit here.
What is vitally important to determine in this setting, he adds, "is
whether it's atenolol that's bad or whether it's reduction of heart rate
that's bad." This is crucial because there are other drugs that aren't
beta blockers that lower heart rate, he explained, such as the new agent
ivabradine (Procoralan, Servier). "This issue needs resolving because if
it's heart-rate reduction [that is the cause], then that's bad news, and
we need to know about it."
Bradycardia not synonymous with cardioprotection in hypertension
In the new review, Bangalore et al included nine randomized controlled
trials evaluating beta blockers for hypertension that also reported
heart-rate data, including 34�096 patients taking beta blockers, 30�139
taking other antihypertensives, and 3987 receiving placebo. Of the
patients in the beta-blocker arms, 78% received atenolol, 9% took
oxprenolol, 1% propranolol, and 12% received
atenolol/metoprolol/pindolol or hydrochlorothiazide.
Paradoxically, a lower heart rate (as attained in the beta-blocker group
at study end) was associated with a greater risk for the end points of
all-cause mortality (r=-0.51; p<0.0001), cardiovascular mortality
(r=-0.61; p<0.0001), MI (r=-0.85; p<0.0001), stroke (r=-0.20; p=0.06),
or heart failure (r=-0.64; p<0.0001).
"In contrast to patients with MI and heart failure,
beta-blocker-associated reduction in heart rate increased the risk of
cardiovascular events and death for hypertensive patients," the
researchers conclude.
Messerli told heartwire: "In the past, the term cardioprotection was
synonymous with bradycardia. The more you had bradycardia, the better
the heart was protected. This is not the case in hypertension. This may
be okay post-MI and in heart failure, but it's not okay in hypertension."
In an editorial accompanying the review, Dr Norman M Kaplan (University
of Texas Southwestern Medical Center, Dallas) agrees [2]: "With this
addition to the evidence, beta blockers will surely remain as indicated
for heart failure, for after MI, and for tachyarrhythmias, but no longer
for hypertension in the absence of these compelling indications."
Difficult to extrapolate findings beyond atenolol
Messerli and his colleagues do state in their discussion, however:
"Further studies are needed to establish causation. It should also be
noted that the beta blocker used in the studies was mainly atenolol, and
hence, any meaningful extrapolation of these results to other beta
blockers, including the newer vasodilating beta blockers, should be done
with caution."
Any meaningful extrapolation of these results to other beta blockers,
including the newer vasodilating beta blockers, should be done with
caution.
Cockcroft contends that because this new review contains studies almost
exclusively using atenolol, "this doesn't move the argument forward very
much." Atenolol, he says, "has been tried and found guilty, and yet
around 40% of prescriptions for beta blockers in the UK and in the US
are still for atenolol. Atenolol should not be given to anybody. Nobody
disagrees that atenolol is guilty, and yet we are still using it."
He says that people think lowering heart rate is good, "because it
reduces the amount of cyclical stress on the aorta, but if at the same
time you are putting the central aortic pressure up, these things may
cancel each other out." Atenolol has been compared in this respect with
one of the newer vasodilating beta blockers, nebivolol (Bystolic,
Forest/Mylan), and it was found that atenolol increases the central
aortic pressure but nebivolol does not [3], he notes.
"The newer vasodilating beta blockers may well not have any of these
detrimental effects. Because they are vasodilatory, they may well offset
the slowing of heart rate by decreasing wave reflection from the
periphery and, in the case of nebivolol, by releasing nitric oxide, an
endogenous vasodilator with antiatherogenic activity," he adds.
To beta block or not, that is the question
Regarding the role now of beta blockers in hypertension, Messerli
commented to heartwire: "Beta blockers in hypertension are not very
useful, and you probably should use any other single drug first before
you add a beta blocker, and if you want to add a beta blocker, please
use a vasodilating one such as carvedilol or nebivolol."
Atenolol should not be given to anybody. Nobody disagrees that atenolol
is guilty, and yet we are still using it.
Cockcroft agrees with much of this, but maintains that beta blockade is
still very important. "Beta blockade is vital. A large number of
patients with hypertension have angina as well, so they've got to have a
beta blocker. Furthermore, there is now evidence that younger subjects
with hypertension (<50 years of age) may well be better treated with a
beta blocker than older hypertensives, as they have a different
hemodynamic form of hypertension. It's what beta blocker you give them
that counts, and it shouldn't be atenolol."
He believes the continued obsession with atenolol is "partly due to
cheapness and habit, but also due to the failure of the people with good
beta blockers to disseminate information on the deleterious effects of
atenolol."
Most important issue still not resolved; central pressure should be the
focus
Cockcroft says the more vital issue "that still needs resolving is
whether it's atenolol that is bad or heart-rate reduction that is bad
news. If it's the latter, we need to know about it, because there are
other drugs that lower heart rate, such as ivabradine, and if you look
at the BEAUTIFUL trial with this new drug, it was very negative."
He believes a trial directly comparing ivabradine with atenolol in terms
of central aortic pressure is needed, "and then you look at the effects
on hemodynamics in terms of central pressure."
Another way of examining this issue could be to give atenolol to people
who have pacemakers in to slow their heart rate down and then switch the
pacemaker back on and bring the heart rate back up to the baseline
level�still with them having atenolol on board�and "if the detrimental
hemodynamics go away, then it's all heart rate, and if it doesn't, then
atenolol has some effect beyond heart-rate reduction that is bad.
"These are very, very important mechanistic experiments that need to be
done now that we have other drugs that lower heart rate that aren't beta
blockers, and we clearly need to be doing these studies," Cockcroft
stresses.
"I personally think that it's the atenolol that is bad and that it has
some effects beyond heart-rate reduction that are bad, but we don't know
from this Messerli review. If half [the trials they included] had used
another beta blocker, then you would know for sure."
"It's central pressure that the pharmaceutical industry should be
focusing on," he adds, "because different drugs, especially beta
blockers, have differential effects on central pressure, and we know
from the Strong Heart Study that central aortic pressure is a better
predictor of outcome than pressure in the arm."
Messerli is a member of the speakers' bureau for Abbott,
GlaxoSmithKline, Novartis, Pfizer, AstraZeneca, Bayer, Boehringer
Ingelheim, Bristol-Myers Squibb, Forest, Sankyo, and Sanofi and has
received research funding/grants from GlaxoSmithKline, Pfizer, Novartis
and CardioVascular Therapeutics. Cockcroft is on the advisory board of
Forest, which markets nebivolol, and has received research funding from
the company.
Sources
1. Bangalore S, Sawhney S, and Messerli FH. Relation of beta-blocker
induced heart rate lowering and cardioprotection in hypertension. J Am
Coll Cardiol 2008; 52: 1482-1489.
2. Kaplan NM. Beta-blockers in hypertension. Adding insult to injury.
J Am Coll Cardiol 2008; 52: 1490-1491.
3. Dhakam Z, Yasmin, McEniery CM, et al. A comparison of atenolol and
nebivolol in isolated systolic hypertension. J Hypertens 2008; 26:
351-356.
Related links
� BEAUTIFUL for some: No overall advantage of ivabradine, but
high-heart-rate patients may benefit
[Clinical cardiology > Clinical cardiology; Aug 31, 2008]
� New review "beats the drum" for not using beta blockers in
uncomplicated hypertension
[Lipid/Metabolic > Lipid/Metabolic; Aug 08, 2007]
� Central aortic pressure readings seen as more prognostic than
standard brachial pressure
[Prevention > Prevention; Jun 18, 2007]
� Cochrane review: Beta blockers should not be first line for
hypertension
[HeartWire > News; Feb 02, 2007]
� New UK hypertension guidelines omit beta blockers for routine use
[HeartWire > News; Jul 06, 2006]
CAFE published: Amlodipine/perindopril combo reduces central aortic BP
[Hypertension > Hypertension; Feb 21, 2006]
......................
: J Am Coll Cardiol. 2008 Sep 23;52(13):1062-72.
Links
Beta-blockers for primary prevention of heart failure in patients with
hypertension insights from a meta-analysis.
Bangalore S, Wild D, Parkar S, Kukin M, Messerli FH.
Department of Medicine, Division of Cardiology, St Luke's Roosevelt
Hospital and Columbia University College of Physicians and Surgeons, New
York, New York 10019, USA.
OBJECTIVES: This study sought to evaluate the efficacy of beta-blockers
(BBs) for primary prevention of heart failure (HF) in patients with
hypertension. BACKGROUND: The American College of Cardiology/American
Heart Association staging for HF classifies patients with hypertension
as stage A HF, for which BBs are a treatment option. However, the
evidence to support this is unknown. METHODS: We conducted a
MEDLINE/EMBASE/CENTRAL search of randomized controlled trials that
evaluated BB as first-line therapy for hypertension with follow-up for
at least 1 year and with data on new-onset HF. The primary outcome was
new-onset HF. Secondary outcomes were all-cause mortality,
cardiovascular mortality, myocardial infarction, and stroke. RESULTS:
Among the 12 randomized controlled trials, which evaluated 112,177
patients with hypertension, BBs reduced blood pressure by 12.6/6.1 mm Hg
when compared with placebo, resulting in a 23% (trend) reduction in HF
risk (p = 0.055). When compared with other agents, the antihypertensive
efficacy of BBs was comparable, which resulted in similar but no
incremental benefit for HF risk reduction in the overall cohort (risk
ratio: 1.00; 95% confidence interval: 0.92 to 1.08), in the elderly (>
or =60 years) or in the young (<60 years). Analyses of secondary
outcomes showed that BBs confirmed similar but no incremental benefit
for the outcomes of all-cause mortality, cardiovascular mortality, and
myocardial infarction but increased stroke risk by 19% in the elderly.
CONCLUSIONS: In hypertensive patients, primary prevention of HF is
strongly dependent on blood pressure reduction. When compared with other
antihypertensive agents, there was similar but no incremental benefit of
BBs for the prevention of HF. However, given the increased risk of
stroke in the elderly, BBs should not be considered as first-line agents
for prevention of HF.
PMID: 18848139 [PubMed - in process
.
--
Garden in shade zone 5 S Jersey USA
bigvince
mainstay against hypertension and it now appears it may actually
damage the heart.
http://www.eurekalert.org/pub_releases/2009-11/uoia-cst112009.php
" Carvedilol shown to have unique characteristics among beta
blockers"
CHAMPAIGN, Ill. — In a new study, researchers report that a class of
heart medications called beta-blockers can have a helpful, or harmful,
effect on the heart, depending on their molecular activity.
The study, which appears in the journal Circulation Research, found
that beta-blockers that target both the alpha- and beta-receptors on
the heart muscle offer the most benefit to cardiac patients, while
those that target only the beta-receptors can actually undermine the
structure and function of the heart.
Circulation Research is published by the American Heart Association.
Heart disease is the leading cause of death in the United States.
Patients with heart disease usually have higher levels of
catecholamines – hormones that activate the beta-adrenergic receptors
to stimulate cardiac muscle contraction. In this process, the heart
initially grows to become a more efficient pump. Unfortunately, the
researchers found, this growth also predisposes the heart to eventual
failure.
Traditionally, beta-blockers targeting the beta-adrenergic receptors
have been utilized as a long-term therapy for heart failure.
Interestingly, blocking adrenergic receptors has been widely used
clinically for nearly 50 years without a full understanding of the
molecular consequences of these drugs, said co-author and graduate
student David Cervantes. Kevin Xiang, a professor of molecular and
integrative physiology at the University of Illinois led the study.
The research team also included researcher Catherine Crosby........"
Atenolol is a selective blocker the kind that as the study notes
'while those that target only the beta-receptors can actually
undermine the structure and function of the heart...."
....
A while back I remember a David I believe from Harvard ; I wonder if
the science has caught uo with him ?
Thanks Vince
Robert Miles
news:772c5fe1-f71e-48bc...@e20g2000vbb.googlegroups.com...
.
Don't count on it always being that way. I had to discontinue my
blood pressure medicines after they made my blood pressure so
low that I started falling down, WITHOUT getting dizzy first.
Robert Miles
Tom Cular
about 1.5 hours, got out to go into a store and dropped with no warning..
Tom
"Robert Miles" <rober...@teranews.com> wrote in message
news:a9DTm.86925$Wf2....@newsfe23.iad...
Jason
<rober...@teranews.com> wrote:
Hello,
There is a disease called "renal artery stenosis". Another name for that
disease is "renovascular hypotension". According to an emedicine report,
"the prevalence may be up to 60% in patients older than 70 years." If
someone has that disorder, they will have high blood pressure until they
get angiography on the renal (kidney) arteries.
Jason