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Drugs for hypertension—a dead end

Drugs for hypertension—a dead end

In medical school, I was told “Always use a new drug while it still works.” I thought they were kidding. But just like everything else, the older you get the more you learn about the ways of the world. Medicine is no exception.

Twenty-five years ago, doctors were all excited about a new class of drugs for treating high blood pressure.

Beta-blockers (the “new class of drugs” from 20 years earlier) had failed them, so they needed a new miracle. They got it in the form of calcium channel blockers (CCBs), which were an instant hit. As with most new drugs for blood pressure, they appeared to work.

Now, nine studies have shown that the miracle CCBs don’t work any better than the older, less expensive drugs. In fact, the CCBs failed to reduce the risk of other heart problems as much as the older medications (diuretics, ACE inhibitors and beta-blockers).

All of the drugs, including the CCBs, were equally effective in lowering blood pressure. However, CCBs were no match for the older drugs when it came to reducing cardiovascular events. Compared to patients taking the old drugs, those taking CCBs were about 26 percent more likely to have a heart attack and 25 percent more likely to experience congestive heart failure than those patients on the older and cheaper drugs.

Your blood pressure is elevated for a reason

Now back to basics. I have maintained for more than 30 years that lowering blood pressure with drugs is a dangerous and irrational business. The pressure is elevated for a reason; it’s probably a compensatory mechanism to keep the patient going while the doctors try to figure out what the real problem is. After 75 years of drug therapy for hypertension, we STILL don’t know the cause of the disease-or even what the disease is.

Most patients are unaware that the drugs don’t work effectively. They lower the pressure only about 10 percent, and it’s just as well. If they really worked at lowering the pressure, say 20 or 30 percent, there would be serious physiological signs and symptoms with consequent strokes or heart attacks, especially the former. So the drugs give the appearance of helping the patient avoid heart disease and stroke by lowering the pressure a little bit without actually working in a meaningful way, which would get the patient in serious trouble. It’s a bad situation all round, basically a swindle.

However, if you are taking a CCB, don’t abruptly stop taking it. The drug thinks it owns your body, and sudden cessation will make for a nasty business. It can be deadly.

Since all types of drugs reduced blood pressure to a similar extent, the lack of cardiac benefits among CCB users suggests that lowering blood pressure alone is not enough to prevent heart attacks and other complications, according to head researcher Dr. Marco Pahor of Wake Forest University.

So another old doctor’s tale-”controlling blood pressure prevents heart disease”-goes into the historical trash bag. It’s nice to be justified in the destruction of an ancient medical myth by a distinguished medical researcher like Dr. Pohar. RH

Reference:

“Health outcomes associated with calcium antagonists compared with other first-line antihypertensive therapies: a meta-analysis of randomized controlled trials.” Lancet 2000; 356: 1,949-1,954

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